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ORTHODONTIA, 


OR 


MALPOSITION  OF  THE  HUMAN  TEETH ; 
ITS  PREVENTION  AND  REMEDY. 


BY 

S.  H.  GUILFORD,  A.M.,  D.D.S.,  Ph.D., 

Peofessoe  of  Operative  and  Peosthetic  Dentistry  and  Dean  of  the  Philadel- 
phia Dental  College;  Author  of  "Niteous  Oxide,"  &c. 


Approved  by  the  National   Association    of    Dental   Faculties    as  a  text- 
book for  use  in  the  schools  of  its  representation. 


THIRD  EDITION.  REVISED  AND  ENLARGED. 


PHILADELPHIA  : 
PRESS  OF  T.  C.  DAVIS  &  SONS, 

529  COMMERCE  street. 


Entered  according  to  Act  of  Congress,  in  the  year  1898,  by 

S.  H.  GUILFOED, 

In  the  OflSce  of  the  Librarian  of  Congress,  at  Washington,  D.  C. 


To   ALL 
THOSE,    WHETHEB  TeACHEKS, 

Practitioners  or  Students,  who  are 

DEEPLY   interested   IN   THE   ART   AND   SCIENCE   OP 

Orthodontia,  this  Third  Edition  is  respectfully  inscribed. 


Preface  to  First  Edition. 


This  work  has  been  written  at  the  request  of  the  National 
Association  of  Dental  Faculties  in  furtherance  of  its  plan  to 
secure  the  preparation  of  a  series  of  text-books  for  use  in 
American  Dental  Colleges.  After  its  completion  and  exami- 
nation, it  was  accepted  and  endorsed  by  the  Association  at 
its  meeting  in  Saratoga,  August,  1889. 

The  impartment  of  instruction  in  the  simplest  and  most 
direct  manner  being  the  true  province  of  a  text-book,  the 
author  has  endeavored  in  the  preparation  of  this  work  to 
treat  the  subject  as  concisely  as  possible,  and  to  clothe  his 
thoughts  and  those  of  others  in  such  language  as  to  be 
readily  comprehended  by  beginners  as  well  as  those  some- 
what advanced  in  this  branch  of  study. 

In  the  treatment  of  the  subject,  the  aim  has  been  to  lead 
the  student  step  by  step  from  the  simplest  beginnings  to 
the  more  complicated  and  difficult  work  of  practical  treat- 
ment. To  this  end,  the  underlying  principles  of  the  art  are 
first  elucidated,  after  which  the  principal  methods  employed 
are  explained,  and  lastly,  the  correlation  of  principles  and 
methods  is  shown  in  their  practical  application  to  typical 
cases.  In  Part  III.,  the  different  forms  of  irregularity, 
together  with  a  variety  of  plans  for  their  correction,  are 
arranged  under  such  headings  and  in  such  order  as  to  be 
readily  referred  to  in  seeking  aid  for  cases  that  occur  in 
office  practice. 


VI.  PREFACE. 

Should  the  work  fulfill  the  object  aimed  at  in  its  prepa- 
ration, the  author  will  feel  amply  repaid. 

Credit  for  assistance  is  most  cheerfully  given  to  the 
twenty-five  teachers  of  this  branch  in  American  Dental 
Colleges  who  have  read  this  work  in  manuscript,  and  by 
friendly  criticism  and  valuable  suggestions  added  much  to 
its  completeness. 

The  author  would  also  acknowledge  his  indebtedness  to 
Prof.  W.  F.  Litch  for  valuable  services,  and  to  the  S.  S. 
White  Co. ;  Lea,  Brothers  &  Co. ;  P.  Blakiston,  Son  &  Co. ; 
and  other  publishers  and  authors  for  the  use  of  certain  cuts. 

S.  H.  G. 
Philadelphia,  Sept.,  1889. 


Preface  to  Third  Edition. 


Owing  to  the  rapid  strides  in  both  the  science  and  art  of 
this  branch  of  dental  practice  the  author,  in  preparing  the 
present  third  edition  of  his  work,  has  taken  advantage  of 
the  opportunity  thus  afforded  to  introduce  many  clianges 
and  improvements. 

The  work  has  largely  been  rewritten,  its  size  increased  by 
more  than  twenty-five  pages,  and  some  fifty  new  illustra- 
tions introduced.  Much  of  the  material  contained  in  former 
editions,  which  had  ceased  to  be  of  value,  has  been  excluded 
and  its  place  supplied  by  newer  matter  and  methods.  Every 
chapter  has  been  more  or  less  changed  to  conform  to  present 
knowledge  and  three  new  chapters  introduced.  One  of 
these,  "Dynamics  of  Tooth  Movement,"  (Part  I.,  Chapter 
VIII.,)  together  with  the  introduction  of  many  new  and 
etymologically  correct  terms  will,  it  is  believed,  add  to  the 
scientific  value  of  the  work.  The  addition  of  a  word  index 
should  prove  of  service  to  the  busy  practitioner. 

The  favorable  reception  given  to  former  editions,  as  shown 
by  its  being  placed  upon  the  list  of  required  text-books  of 
many  dental  colleges,  encourages  the  author  to  believe  that 
the  usefulness  of  the  present  edition  wdll  be  augmented. 

The  second  edition  was  translated  into  French  and  the 
present  one  is  now  about  to  be  published  in  Spanish. 

The  author  would  express  his  indebtedness  to  the  follow- 
ing fellow-teachers  of  this  branch  for  valuable  aid  and  sug- 

vii. 


Vlll.  PREFACE. 

gestions :  Professors  C.  L.  Goddard  of  San  Francisco,  C.  S. 
Case  of  Chicago,  E.  H.  Angle  of  St.  Louis  and  V.  E.  Jack- 
son of  New  York. 

He  would  also  acknowledge  the  kindness  of  the  S.  S. 
White  Dental  Mfg.  Co.,  the  Consolidated  Dental  Mfg.  Co., 
Lea,  Brothers  &  Co.,  H.  D.  Justi  &  Son.,  B.  H.  Catching  and 
other  publishers,  in  furnishing  electrotypes  of  many  illus- 
trations. 

S.  H.  G. 
Philadelphia,  July,  1898. 


CONTENTS 


PART   I. 
PRINCIPLES   INVOLVED. 


Chapter  I. 

PAGE. 

Regularity  and  Irregularity  Defined,       ....  9 

Chapter  II. 

ETIOLOGY. 

Heredity — Long  Retention  of  Deciduous  Teeth — Early 
Extraction  of  Deciduous  Teeth — Injudicious  Extrac- 
tion— Delayed  Eruption — Supernumerary  Teeth — 
Accidents — Adenoid  Vegetations — Habiis — Superior 
Protrusion — Inferior  Protrusion — Lancet-Arch — Con- 
stricted-Arch,        12 

Chapter  III. 

EVILS    RESULTING    FROM   IRREGULARITY. 

Appearance  Marred — Speech  Affected — Mastication  Im- 
paired— Caries  Induced, 29 

Chapter  IV. 

ADVISABILITY   OF   CORRECTION. 

Age  —  Health  —  Sex  —  Power   of   Appreciation  —  Family 

Type — Improvement  of  Occlusion,  ....  32 

Chapter  V. 

AGE    AT   WHICH   CORRECTION   MAY   BE   BEGUN. 

Early  Interference — When  Justifiable  and  Advisable — 

When  Correction  should  be  Delayed,  ...         -37 

ix. 


X.  CONTENTS. 

Chapter  VI. 

EXTEACTION    AS   EELATED   TO   OETHODONTIA. 

PAGE. 

EuLES  Governing  same, 42 

Chapter  VII. 

PHYSIOLOGY   OF   TOOTH-MOVEMENT. 

Chaeacter  of  Tissues  Involved — The  Alveolab  Process — 
The  Teeth — The  Pulp — The  Pericementum — Physi- 
ological Changes  Occurring  in  the  Moving  of  Teeth,  50 

Chapter  VIII. 

DYNAMICS   OF   TOOTH-MOVEMENT. 

Secure     Anchorage — Proper     Application     of     Force — 

Character  of  Eesistance  to  be  Overcome,    .        .        .58 


PART  II. 

MATERIALS   AND   METHODS. 

Chapter  I. 

Examination  of  Mouth — Impression  and  Articulation — 

Study  of  Case, 70 

Chapter  II. 

APPLIANCES. 

Materials  and  Their  Uses — Desirable  Qualities  in  an 

Appliance — Eetainers, 79 

Chapter  III. 

CONSIDEEATION   OF   METHODS. 
Farrar's — Magill's — Angle's — Coffin's— Jackson's,    .        .  94 


CONTENTS.  XI. 

PART   III. 

PAGE. 

Specific  Foems  of  Iekegularity  and  their  Treatment,   .  115 

Chapter  I. 

Incisor  Teeth  Situated  Without  or  Within  the  Line  of 

the  Arch — Methods  of  Correction,         .        .        .        .  116 

Chapter  II. 

Incisor  Teeth  Situated  Outside  or  Inside  of  the  Line 
of  the  Arch  after  Dentition  is  complete — Cases 
AND  Treatment, 123 

Chapter  III. 
Cuspid  Teeth  Situated  Outside  or  Inside  of  the  Arch,  135 

Chapter  IV. 
Misplaced  Bicuspids, 151 

Chapter  V. 
Torsion — Methods  of  Rotation, 157 

Chapter  VI. 
Contracted  Arch — Differp:nt  Methods  of  Expanding,      .  167 

Chapter  VII. 

Superior  Protrusion — Methods  of  Case — Kingsley — God- 

DARD — Angle — Jackson  and  Author,       ....  175 

Chapter  VIII. 

Inferior  Protrusion — Difficui-ty  of  Correction — Various 

Appliances  and  Methods,  ...  .        .  196 


Xll.  CONTENTS. 

Chapter  IX. 

PAGE. 

Lack  of  Occlusion — Anterior — Posterior — Lateral,  .  204 

Chapter  X. 
Intrusion  and  Extrusion,         . 211 

Chapter  XI. 

Surgical  Correction    or    Immediate  Luxation — Methods 

OF    Tomes— Cunningham — Bryan — Talbot,      .        .        .  220 

Chapter  XII. 

Miscellaneous — Crowded  Lower  Incisors — Tooth  Shaping 

— Closing  Abnormal  Interdental  Spaces,      .        .        .  226 


PART   IV. 
Chapter  I. 

CONSTEUCTION   OF   EEGULATING   APPLIANCES. 

Description  and  Illustration  of  Tools  and  Appliances — 
Making  of  Ferrules  or  Bands — Round  and  Square 
Tubing — Wire  Drawing— Soft  and  Hard  Soldering — 
Screws  and  Nuts — Comparative  Table  of  Gauges,     .  233 

Chapter  II. 

ELECTEO-PLATING. 

Cleansing     Baths — Copper     Solution — Gold     Solution — 

Battery — Plating — Plating  Without  a  Battery,       .  245 


ORTHODONTIA. 


PART  I,    PRINCIPLES  INVOLVED. 


CHAPTER  I. 

Orthodontia,  from  o/>??6c,  right,  correct,  and  dSouq,  a  tooth,  is 
that  branch  of  dental  practice  which  relates  to  the  correction 
or  prevention  of  irregularity  of  position  of  the  human  teeth. 

Its  recognition  as  a  distinct  branch  or  specialty  of  general 
dental  practice  has  come  about  in  recent  years.  Fifty  years 
ago  so  little  was  known  concerning  it  that  the  writers  of  that 
day  paid  little  attention  to  it.  Whether  the  condition  of 
irregularity  was  less  frequently  met  with  then  than  now  we 
cannot  certainly  tell,  but  inasmuch  as  dentistry  was  at  that 
time  in  a  somewhat  primitive  state,  and  as  the  most  pressing 
demands  upon  the  dentist  of  that  day  were  for  the  alleviation 
of  pain,  the  substitution  of  artificial  dentures  to  replace  lost 
members,  and  the  checking  of  the  ravages  of  decay  by  filling, 
it  is  but  natural  to  suppose  that  there  was  little  time  or  in- 
clination to  attempt  the  relief  of  such  an  apparently  unim- 
portant condition  as  mere  irregularity  of  position.  Since 
then,  however,  with  the  natural  growth  of  dental  science  and 
the  enlargement  of  its  sphere,  the  subject  of  orthodontia  has 
grown  in  importance  until  to-day  it  is  engaging  the  attention 
of  some  of  the  best  minds  in  the  profession  and  forms  an 
important  part  of  the  study  of  every  dental  student. 

With  the  growth  of  its  interest  and  importance  theip  has 
been  a  corresponding  advance  in  investigation  as  to  the 
cause  and  frequency  of  irregularities,  a  more  exact  micro- 
scopical  examination   of  the  tissues  involved  and  of  the 

9 


10  ORTHODONTIA, 

physiological  changes  occurring  in  them  in  the  process  of 
correcting  such  conditions.  Progress  has  also  been  marked 
by  a  more  careful  study  of  laws  governing  the  application 
of  force  to  the  moving  of  teeth  and  by  the  invention  of  a 
multiplicity  of  devices  and  appliances  for  the  more  perfect 
and  easy  correction  of  this  class  of  deformities. 

REGULARITY    AND    IRREGULARITY    DEFINED. 

The  teeth  of  man  when  normally  placed  in  the  alveolar 
arch  describe  in  outline  a  parabola  or  semi-ellipse  with  a 
slight  flattening  of  the  curve  in  the  region  of  the  incisor 
and  bicuspid  teeth,  and  a  consequent  tendency  to  angularity 
where  the  cuspids  are  placed.  The  lower  arch  differs  from 
the  uj)per  principally  in  being  slightly  smaller.  The  teeth 
when  thus  placed  should  be  in  contact,  each  one  touching 
its  neighbor  at  the  most  prominent  points  of  its  approximal 
surfaces,  and  with  the  cusps  or  occluding  surfaces  in  such 
position  as  to  properly  occlude  with  those  in  the  opposite  jaw. 
Thus  arranged  the  teeth  are  called  regular,  but  whilst  regular 
as  to  alignment  they  may  still  be  inharmonious  in  relation 
to  other  facial  features  by  either  too  great  prominence  or 
such  a  lack  of  it  as  to  constitute  a  decided  deformity.  Irreg- 
ularity as  most  commonly  met  with  consists  in  a  deviation 
from  the  normal  outline  on  the  part  of  several  or  all  of  the 
teeth,  or  in  the  malposition  of  one  or  more  individual  teeth  ; 
if  the  latter,  the  tooth  or  teeth  may  be  found  outside  or 
inside  of  the  regular  line  of  the  arch  or  they  may  be  placed 
anteriorly  or  posteriorly  to  their  normal  positions,  or  finally, 
they  may  be  turned  or  twisted  on  their  axes.  In  many 
cases  this  torsion  is  associated  w^ith  malposition. 

Irregularity  being  an  abnormity,  corrective  measures, 
as  a  rule,  should  be  resorted  to,  but  slight  irregularities  do 
not  always  demand  interference. 

The  slight  overlajDping  of  the  superior  centrals  by  the  lat- 
>erals,  for  instance,  is  a  clear  case  of  irregularity,  but  it -is  so 


DEFINITION    OF    IRIIEGULARITY.  11 

slight  and  so  commonly  met  with,  that  it  has  almost 
ceased  to  attract  attention  or  to  be  regarded  as  an  abnorm- 
ity. Artificial  teeth  are  now  made  reproducing  this  condi- 
tion and  in  many  cases  are  preferred  on  account  of  their 
"  more  natural  appearance." 

So  too,  the  slight  irregularity  commonly  found  in  connec- 
tion with  the  inferior  incisors,  where  several  or  all  of  them 
are  slightly  turned  and  overlapping,  is  no  longer  looked 
upon  as  inharmonious  and  is  also  imitated  in  the  arrange- 
ment of  artificial  teeth. 

Again,  the  slight  misplacement  of  a  tooth  in  the  posterior 
part  of  the  arch,  where  it  is  not  noticeable,  may  be  left 
without  disturbance  and  no  harm  result. 

In  cases  like  these,  if  the  slightly  altered  position  of  the 
individual  teeth  is  not  likely  to  result  in  injury  to  tooth 
structure,  or  does  not  interfere  with  speech  or  occlusion,  it  is 
best  to  omit  any  effort  toward  correction. 


CHAPTER  II. 

ETIOLOGY. 

The  causes  responsible  for  the  production  of  irregularity 
are  many  and  at  best  but  imperfectly  understood.  Some  of 
them  are  operative  before  the  birth  of  the  individual  and 
others  afterward.  They  may  therefore  be  classed  under  the 
two  general  heads  of  Hereditary  and  Acquired. 

HEREDITARY. 

This  class  comprises  all  such  cases  as  are  evidently  due  to 
the  inheritance  of  peculiarities  that  existed  in  their  near  or 
remote  ancestors, -or  to  some  of  the  characteristics  of  both 
parents  who  were  themselves  free  from  dental  abnormity. 

The  well  known  biological  law  of  transmission  of  charac- 
teristics from  parent  to  child  will  readily  explain  how  the 
abnormalities  as  well  as  the  normalities  may  be  transmitted. 
The  child  may  bear  a  close  resemblance  to  either  parent  in 
form  and  feature,  or  it  may  combine  some  of  the  peculiari- 
ties of  both.  In  other  cases  it  will  resemble  neither,  but  be 
like  one  of  the  grandparents  or  other  remote  relatives. 

The  evidences  of  inheritance  are  perhaps  nowhere  more 
clearly  expressed  than  in  the  dental  organs.  Not  only  in 
these  organs  as  a  whole  may  we  see  the  dental  apparatus  of 
a  progenitor  reproduced  in  entirety,  but  the  resemblance  is 
equally  well  shown  in  the  inheritance  of  so  slight  an  abnor- 
mity as  a  turned  or  misplaced  tooth.  Sometimes  such 
peculiarity  may  be  inherited  by  several  children  in  the  same 
family. 

Cases  of  irregularity  due  to  inheritance  are  oftentimes  the 
most  difficult  to  correct,  for  not  only  must  mechanical  diffi- 
culties be  overcome,  but  in  addition  the  influence  of  physi- 
cal impress,  confirmed  perhaps  by  repeated  transmission, 

12 


ETIOLOGY.  16 

must  be  combatted.  The  mechanical  difficulties  in  such 
cases  are  as  readily  conquered  as  in  others,  but  the  force  of 
inheritance  will  show  itself  in  a  strong  and  stubborn  ten- 
dency on  the  part  of  the  teeth  to  return  to  their  former 
abnormal  positions. 

The  intermarriage  of  races  with  widely  differing  charac- 
teristics has  come  to  be  regarded  as  one  of  the  most  j)rolific 
causes  of  dental  irregularity.  If  both  races  represented  in 
tlie  marriage  possess  somewhat  similar  characteristics  as  to 
size,  vigor  and  feature,  no  dental  peculiarity  will  usually  be 
found  in  the  offspring ;  but  where  the  differences  are  marked, 
irregularity  of  the  teeth  will  often  be  the  result. 

When  one  parent  possesses  a  large  frame  with  full-sized 
teeth  set  in  large  jaws  and  the  other  a  small  frame  with  cor- 
respondingly small  jaws  and  small  teeth,  the  child  may 
inherit  the  large  teeth  of  one  parent  and  the  small  jaws  of 
the  other.  The  small  jaws  cannot  accommodate  the  full 
complement  of  the  larger  teeth,  and  hence  a  crowded  and 
irregular  dental  arch  will  be  the  result.* 

Where  the  small  teeth  of  one  parent  and  the  large  jaws 
of  the  other  are  found  united  in  the  offspring,  abnormal  in- 
terdental spaces  will  frequently  be  the  result.  These  spaces 
may  exist  between  all  of  the  teeth,  or,  as  in  some  cases,  the 
deformity  will  only  be  found  in  connection  with  the  anterior 
ones.  Cases  of  this  character,  fortunately,  are  infrequently 
met  with,  but  when  they  occur  they  present  an  unsightly 
appearance,  and  generally  result  in  an  earlier  loss  of  the 
teeth  from  that  lack  of  contact  and  mutual  support  so 
necessary  to  their  longest  retention  and  usefulness. 

*Dr.  J.  M.  Whitney,  of  Honolulu,  in  a  paper  read  before  the  World's 
Columbian  Dental  Congress  in  1893,  entitled,  "Among  the  Ancient  Hawai- 
ian s"  says  : — We  have  often  accounted  for  the  irregularity  of  teeth  found 
so  commonly  among  Americans,  by  the  mixture  of  races  of  which  our  nation 

is  composed But  here  is  a"  people,  isolated  from  all  others  for  at 

least  fourteen  hundred  years,  with  no  admixture  of  races  ;  yet  irregularity 
of  the  teeth  of  both  maxillaries  was  almost  as  common  as  it  is  among  the 
mixed  races  of  to-daj'. 


14  ORTHODONTIA. 

ACQUIEED. 

The  causes  productive  of  irregularity  during  dentition  or 
subsequent  to  it  far  exceed  in  number  those  due  to  heredity. 

Long  Retention  of  Deciduous  Teeth.' — In  accordance  with 
pliysiological  law,  the  deciduous  teeth  are  intended  to  sub- 
serve the  wants  of  the  chil^d  until  replaced  by  the  permanent 
set.  The  crown  of  the  permanent  tooth  should  occupy  a 
position  beneath  or  adjacent  to  the  root  of  the  deciduous  one 
which  it  is  intended  to  supplant.  Then,  as  the  root  of  the 
temporary  tooth  is  gradually  resorbed,  the  permanent  tooth 
advances  and  finally  occupies  the  position  previously 
occupied  by  its  predecessor. 

It  frequently  happens,  however,  that  the  crypt  of  the  per- 
manent tooth  is  situated  at  some  little  distance  from  the 
root  of  its  corresponding  deciduous  one,  and  as  the  new 
tooth  makes  its  way  into  place  it  assumes  a  position  to  the 
side  of  the  deciduous  root.  As  usually  that  part  of  the  root 
is  resorbed  which  is  in  contact  with  the  vascular  covering 
of  the  advancing  crown,  a  portion  of  the  length  of  the  root 
remains  unabsorbed,  and  the  new  crown  is,  in  consequence, 
compelled  to  advance  by  the  side  of  the  root  instead  of 
beneath  it.  The  deciduous  tooth  as  a  result  of  its  only  par- 
tially resorbed  root,  remains  firm  in  place,  and  the  new  one 
is  erupted  out  of  its  proper  position.  Had  the  condition 
been  brought  to  the  attention  of  the  dentist  before  the  new 
crown  appeared,  the  extraction  of  the  deciduous  tooth  would 
have  permitted  the  advancing  tooth  to  assume  its  proper 
position  in  the  arch  and  irregularity  have  been  prevented. 
When  the  permanent  tooth  is  advancing  out  of  position  the 
fact  may  be  recognized  by  the  unusual  distension  of  the  gum 
and  alveolar  plate  beneath,  and  the  deciduous  tooth,  no  mat- 
ter how  firmly  set,  should  at  once  be  removed.  Even  the 
spicula  of  a  deciduous  root  has  been  found  sufficient  to  de- 
flect a  permanent  tooth  from  its  course  during  eruption. 

Early  Extraction  of  Deciduous  Teeth. — That  the  premature 
extraction  of  deciduous  teeth  often  prepares  the  way  for 


ETIOLOGY.  15 

irregularity  of  the  permanent  set  is  generally  recognized, 
but  the  extent  of  its  importance  and  the  manner  in  which 
it  operates  can  best  be  understood  by  considering  the  phy- 
siological facts  in  the  case. 

Irregularity  of  the  deciduous  teeth  is  a  condition  very 
seldom  met  with.  As  a  rule  they  occupy  their  normal  posi- 
tion in  an  alveolar  arch  of  proper  size  to  accommodate 
them,  and  this  again  rests  upon  a  jaw  bone  of  suitable 
amplitude.  Thus  jaw,  process  and  teeth  are  harmoniously 
correlated.  As  each  deciduous  tooth  is  lost  it  is  succeeded  by 
the  corresponding  permanent  one,  which,  under  normal 
conditions,  will  occupy  the  space  created  by  the  removal  of 
its  predecessor.  In  this  way,  one  by  one,  j^he  permanent  set 
should  make  its  appearance  until  all  of  the  deciduous  teeth 
have  been  supplanted  by  their  permanent  successors. 

The  permanent  teeth  are  all  larger  than  the  corresponding 
ones  of  the  deciduous  set,  with  one  excejDtion, — the  second 
bicuspid.  This  being  the  case,  they  require  a  larger  alveo- 
lar arch  and  a  correspondingly  larger  jaw  bone  for  their 
accommodation.  This  nature  furnishes  by  the  slow  process 
of  enlargement  by  interstitial  growth,  which  is  hastened 
and  stimulated  by  the  lateral  pressure  of  the  teeth  as  they 
make  their  way  into  place,  and  afterward.  When  the  first 
permanent  molar  makes  its  appearance  it  is  obliged  to 
provide  sufficient  accommodation  for  itself  by  forcing  its 
way  between  the  deciduous  second  molar  and  the  strong 
maxillary  tuberosity  above  or  the  equally  resistant  ramus 
below.  This  pressure  is  felt  by  all  of  the  other  teeth  in  the 
arch.  If,  therefore,  any  of  the  deciduous  molars  should  be 
extracted  about  the  fifth  or  sixth  year,  for  instance,  as  they 
too  often  are  after  having  been  impaired  by  disease,  the 
permanent  molar  will  move  forward  and  occupy  part  of  the 
space  intended  for  the  bicuspids. 

When  the  permanent  lower  central  incisors  erupt  they 
make  their  appearance  inside  of  the  line  of  the  deciduous 
ones,  which  soon  loosen  and  drop  out.     Owing  to  the  fact 


16  ORTHODONTIA. 

that  the  width  of  these  new  teeth  is  considerably  greater 
than  that  of  their  predecessors,  they  naturally  overlaj)  to  a 
certain  extent  the  adjoining  deciduous  laterals.  This  over- 
lapping prevents  the  centrals  from  moving  forward  into  line 
in  the  arch.  When  the  permanent  laterals  erupt  they 
assume  a  position  by  the  side  of  the  centrals,  and  to  find 
accommodation  in  this  contracted  space  inside  of  the  arch 
several  or  all  of  them  are  apt  to  be  crowded  into  irregular 
positions. 

This  condition,  from  the  fact  that  these  teeth  have  erupted 
too  rapidly  to  admit  of  a  corresponding  increase  in  size  of 
the  alveolar  arch,  is  often  regarded  as  a  serious  evil,  and  to 
correct  it,  the  inexperienced  practitioner  will  in  many  cases 
extract  the  temporary  cuspids  which  are  designed  for  reten- 
tion until  years  afterward.  This  additional  space  having 
been  thus  furnished,  the  permanent  incisors  will  move  for- 
ward into  line  and  assume  a  regular  position. 

Later,  when  the  bicuspids  appear,  they  will  usually  find 
no  difficulty  in  assuming  places  in  the  arch,  because  their 
predecessors  occupied  a  larger  space  and  because  the  cuspids 
are  missing,  but  from  the  very  abundance  of  the  space  and 
the  pressure  of  the  first  molar  from  behind,  the  bicuspids 
will  very  soon,  if  not  at  once,  be  so  pressed  forward  that  the 
first  bicuspid  will  come  in  contact  with  the  lateral,  leaving 
no  space  for  the  accommodation  of  the  cuspid  when  it  makes 
its  appearance  at  about  the  eleventh  or  twelfth  year. 

Such  "being  the  case,  the  cuspid  must  of  necessity  erupt 
outside  or  inside  of  the  line  of  the  arch,  and  produce  a 
deformity  both  unsightly  and  hard  to  correct. 

Had  the  temporary  cuspids  not  been  extracted,  they 
would  have  preserved  space  for  their  successors,  and  the 
inlocked  and  irregular  incisors,  in  the  course  of  time,  by  tlie 
normal  enlargement  of  the  arch,  and  the  excess  provided 
by  the  removal  of  the  deciduous  molars,  would  have  had 
space  sufficient,  which  nature,  assisted  by  the  pressure  of  the 
tongue,  would  aid  them  in  occupying. 


ETIOLOGY.  17 

The  same  condition  is  met  with  in  the  superior  arcli,  per- 
haps more  frequently  than  in  the  inferior.  Here  the  incis- 
ors erupt  outside  of  the  line  of  the  deciduous  ones,  and  some- 
times apj)ear  in  an  irregular  and  crowded  position,  to  correct 
which  the  temporary  cuspids  are  often  needlessly  sacrificed, 
and  the  same  train  of  evils  follows. 

It  will  thus  be  seen  that  the  premature  extraction  of  any 
of  the  temporary  teeth,  especially  the  cuspids,  cannot  well 
result  in  other  than  harm  to  the  permanent  ones,  so  far  as 
regularity  is  concerned. 

Sir  John  Tomes  relates  a  case  in  which  he  extracted  for 
cause  all  of  the  deciduous  teeth  of  a  child,  and  yet  when 
tlie  permanent  ones  appeared  they  assumed  their  proper 
positions  in  the  arch  without  any  resultant  irregularity. 

This  one  case,  however,  the  only  one  of  the  kind  on 
record,  does  not  disprove  the  facts  as  noticed  in  thousands 
of  cases  of  opposite  character,  nor  does  it  confute  the  plainly 
apparent  workings  of  physiological  law.  It  simply  illus- 
trates what  nature  may  do  in  a  single  case  under  conditions 
exceptionally  favorable. 

Injudicious  Extraction  of  Permanent  Teeth. — A  condition 
frequently  met  with  after  all  the  permanent  teeth  have  been 
erupted,  is  one  where  in  the  upper  jaw  the  centrals,  bicuspids 
and  molars  are  all  harmoniously  arranged,  while  the  laterals 
occupy  a  position  inside  of  the  line  of  the  arch  and  the 
cuspids  lie  outside  of  it.  The  condition  is  most  frequently 
brought  about  by  the  premature  extraction  of  one  or  more 
teeth  of  the  temporary  set,  as  described  under  the  last 
heading. 

To  remedy  the  difficulty  in  the  easiest  manner,  some 
practitioners  have  at  times  extracted  the  laterals  and  on 
other  occasions  the  cuspids.  The  result  has  been  in  each 
case  an  almost  hopeless  deformity.  The  cuspids  brought 
next  to  the  centrals  oftentimes  gives  to  the  face  a  canine 
appearance,  while  with  cuspids  lacking  the  countenance  is 
robbed  of  that  prominence  near  the  angles  of  the  mouth 
so  necessary  to  harmonious  expression. 


18  ORTHODONTIA. 

.  Again,  the  permanent  first  molars  of  one  of  the  jaws  are  ■ 
often  neglected  until  caries  has  made  serious  inroads  upon 
them,  when  they  are  extracted  as  offending  members.  The 
result  is  that  the  lateral  pressure,  so  necessary  to  proper 
expansion  of  the  process  is  lacking  in  one  jaw,  while  in  the 
other  the  normal  enlargement  continues.  As  a  consequence 
there  is  disparity  as  to  size  between  the  two  jaws,  and  the 
appearance  of  the  individual  is  perhaps  permanently 
marred. 

Delayed  Eruption  of  Permanent  Teeth — It  sometimes  hap- 
pens, from  causes  not  easily  definable,  that  the  eruption  of 
one  or  more  of  the  permanent  teeth  is  retarded  to  such  a 
degree  that  the  rest  of  the  set  take  positions  in  the  arch  and 
occupy  all  of  the  space.  When  the  tardy  member  is  ready 
to  erupt  there  is  no  place  for  it,  and  it  is  compelled  to  take 
a  position  outside  or  inside  of  the  line.  This  is  apt  to  occur 
more  frequently  with  the  cuspids  than  any  of  the  other 
teeth,  although  it  is  occasionally  met  with  in  the  case  of 
laterals  and  bicuspids. 

Supernumerary  Teeth. — Supernumerary  teeth  are  very  fre- 
quently found  occupying  a  position  in  the  arch  before  the 
eruption  of  the  permanent  set,  so  that  when  the  latter  appear 
Fig.  1.  there  is  insufficient  room  for 

some  of  their  number,  and 
these  are  forced  to  assume  an 
abnormal  position.  Such  su- 
pernumerary teeth  as  apj^ear 
in  the  line  of  the  arch  and 
in  the  anterior  part  of  the 
mouth  are  usually  small  and 

Torsion  caused  by  Supernumerary.  of  the  COuical  Or  peg-tOOth  Va- 

riety, and  are  most  frequently  found  between  the  central 
incisors. 

Fig.  1  represents  a  case  of  this  kind  in  the  mouth  of  a 
Japanese  boy,  nine  years  of  age,  in  which  as  a  result  of  the 


Fig. 

2. 

/-\ 

/^ 

— 

r^" 

L.>-, 

w     -^-^ 

rN 

/ 

\'^  »**  j"^ 

,( 

'* 

i''  1  111 

1          '    * 

^ 

j*^ 

ETIOLOGY.  '  19 

presence  of  the  extra  tooth,  the  right  central  is  turned  at  an 
angle  of  90°,  while  its  mate  is  also  somewhat  rotated. 

Fig.  2  illustrates 
another  case  more 
serious  in  character. 
It  is  that  of  a  boy, 
fourteen  years  old, 
and  shows  a  general 
jumbling  of  all  of  the 
anterior  teeth  due  to 
the  presence  of  two 
supernumerary  later- 
erals  of  regular  size  ,,^^ 

and    form.  General  Displacement  caused  by  supernumerary  Teeth. 

Sometimes  the  presence  of  a  supernumerary  tooth  has  no 
other  effect  upon  the  permanent  set  than  to  occupy  part  of 
the  space  in  the  arch  and  separate  the  adjoining  teeth  by  its 
own  width.*  Even  this,  however,  is  objectionable,  for  in 
most  cases  the  tooth,  being  abnormal  in  form,  will  have  to 
be  extracted  and  an  attempt  made  to  close  the  space  thus 
created. 

Accidents. — An  accidental  injury  to  one  or  more  of  the 
teeth  of  either  set,  whether  resulting  in  their  loss  or  not,  is 
often  responsible  for  an  irregular  condition.  Should  a 
deciduous  tooth  become  devitalized,  as  the  result  of  an  acci- 
dent or  other  cause,  and  alveolar  abscess  supervene,  the 
physiological  act  of  resorption  will  be  suspended,  and  the 
succeeding  tooth  in  the  course  of  its  eruption  will  naturally 
be  deflected  from  its  course  and  erupt  in  an  abnormal 
position 

So,  also,  it  has  happened  that  a  deciduous  incisor,  through 
a  fall,  has  been  driven  up  into  the  process.     Such  a  mis- 


*A  model  in  the  museum  of  the  Philadelphia  Dental  Colle^je  represents 
two  supernumerary  teeth  situated  between  the  superior  central  incisors. 
None  of  the  teeth  are  turned  or  misplaced,  and  but  for  the  presence  of  these 
two  intruders,  the  dental  arch  would  in  all  respects  be  a  typical  one. 


20  ORTHODONTIA. 

fortune  can  hardly  fail  to  cause  an  injury  to  the  partially' 
formed  permanent  tooth  lying  beneath  it.  Should  no  more 
serious  result  follow,  it  will  probably  at  least  divert  the  new 
tooth  from  its  course  and  be  productive  of  irregularity. 

The  author  had  one  such  case  in  his  practice  with  an 
irregularly  placed  permanent  tooth  as  the  result. 

Adenoid  Vegetations. — Within  the  past  ten  years  the  atten- 
tion of  oral  and  aural  surgeons  has  been  especially  directed 
to  the  ill-effects  resulting  from  the  presence  of  adenoid  vege- 
tations in  the  naso-pharynx. 

These  grow^ths  are  often  found  in  children  as  early  as  the 
second  year  of  life,  and  by  partially  or  wholly  closing  the 
posterior  nares,  interfere  greatly  with  natural  breathing 
through  the  nose.  They  also  frequently  cause  marked  im- 
pairment of  hearing  by  impinging  upon  or  closing  the 
mouth  of  the  Eustachian  tube. 

It  has  been  noticed  that  their  presence  is  nearly  always 
associated  with,  and  by  inference  productive  of,  a  pinched 
apjoearance  in  the  superior  maxillary  and  nasal  regions  of 
the  face.  This  condition  is  believed  to  be  attributable  to 
lack  of  development  of  the  frontal,  sphenoidal  and  eth- 
moidal sinuses  and  the  antrum  of  Highmore,  which  being 
normally  in  contact  with  the  air,  cease  to  develop  when  the 
circulation  of  the  air  through  the  nose  is  interfered  with, 
resulting  in  altered  dimensions  of  the  face. 

This  lack  of  development  in  the  osseous  structures  con- 
tiguous to  the  oral  cavity  is  very  likely  to  produce  a  high 
and  contracted  vault  associated  with  a  lancet-arch,  and 
such  condition  of  the  vault  and  arch  has  usually  been  found 
in  cases  where  adenoid  growths,  through  lack  of  discovery, 
have  been  allowed  to  remain  through  a  number  of  years. 

That  these  growths  are  directly  or  indirectly  responsible 
for  the  malposition  of  teeth  (as  has  been  stated  by  some 
medical  writers)  other  than  the  angular  position  of  the 
superior  central  incisors  as  found  in  the  lancet-arch,  we 
have  no  reason  to  believe ;  but  inasmuch  as  any  alteration 


ETIOLOGY  21 

of  the  normal  form  of  the  arch  and  vault  is  in  itself  an 
abnormity,  manifesting  itself  in  the  facial  expression  and 
perhaps  seriously  interfering  with  proper  and  needful  occlu- 
sion of  the  teeth,  it  is  very  important  that  where  the  pre- 
sence of  such  growths  is  suspected,  a  careful  examination  by 
means  of  the  finger  or  mirror  should  be  made,  and,  if  found, 
the  case  should  at  once  be  referred  to  an  oral  surgeon. 

Dr.  W.  A.  Mills*  reports  a  case  in  practice  of  a  boy,  seven 
years  of  age,  in  which  there  was  almost  complete  obstruction 
of  the  nasal  j^assages  associated  with  pinched  and  contracted 
features,  such  as  are  noticed  in  the  habitual  mouth-breather. 
The  tonsils  were  greatly  enlarged  and  deglutition  both  diffi- 
cult and  painful.  An  examination  revealed  a  perceptible 
contraction  of  the  sides  of  the  arch  and  an  elevation  of  the 
hard  palate.  Adenoid  growths  were  discovered  and  re- 
moved and  the  tonsils  reduced  in  size  by  the  galvano 
cautery.  Six  months  later  the  tendency  to  contraction  had 
disappeared,  the  palate  and  arch  had  resumed  their  normal 
form  and  the  jDatient  had  greatly  improved  in  health  and 
appearance.     The  writer  quotes  Dr.  Cryer  as  follows : 

"  It  is  my  opinion  that  an  inflammation  of  the  tonsil  and 
surrounding  tissue  will  cause  tention  of  the  palato-pharyn- 
geus  and  palato-glossus  muscles ;  if  this  be  so,  they  would 
naturally  pull  the  lateral  portion  of  the  arch  downward  and 
inward ;  especially  with  children  when  their  bones  are  soft 
and  yielding." 

Habits. — The  bad  habits  which  young  children  are  apt  to 
acqmre  after  they  are  weaned,  such  as  thumb-,  lip-  or  tongue- 
sucking,  are  important  factors  in  bringing  about  an  irregular 
alignment  of  the  teeth  in  one  or  more  portions  of  the  arch. 
Acquired  early,  while  the  temporary  teeth  are  in  position 
and  firmly  set,  the  habit  will  usually  make  no  impression 
upon  them,  but  if  not  checked  and  allowed  to  continue  up 
to   the  time  of  the   coming   of  the   permanent   set,   as   is 

*Ohio  Dental  Journal,  Sept'r,  1897. 


22  ORTHODONTIA. 

sometimes  the  case,  these  will  generally  be  thrown  out  of 
position  or  so  altered  in  their  relationship  as  to  cause  a 
serious  deformity. 

This  is  readily  accounted  for  when  we  consider  that  the 
erupting  teeth,  seeking  their  position  in  the  arch  and  sur- 
rounded by  newly  formed  and  pliable  alveolar  tissue,  are 
easily  turned  out  of  their  course  by  any  extraneous  force 
exerted  upon  them. 

The  general  results  of  the  triple  habit  are  the  same, 
although  they  vary  in  particulars.  In  thumb-sucking, 
usually  only  two  or  three  of  the  incisors  are  pressed  out  of 
place,  and  the  ones  affected  are  determined  by  the  hand 
used  and  the  position  of  the  thumb  in  the  mouth.  In  lip- 
and  tongue-sucking,  owing  to  the  larger  surface  of  the  organ 
employed,  all  of  the  incisors  will  be  affected. 

Not  only  has  the  point  of  introduction  of  the  thumb  to 
be  considered  in  relation  to  its  effects,  but  also  the  angle  at 
which  it  is  held.  When  the  position  of  the  thumb  in  rela- 
tion to  the  teeth  forms  less  than  a  right  angle,  the  upper 
teeth  will  be  thrown  out  and  the  lower  ones  in ;  but  when 
held  in  a  horizontal  position,  the  upper  and  lower  teeth  are 
not  displaced,  but  simply  held  apart.  As  a  result  of  this 
the  first  molars  are  kept  from  present  contact  and  naturally 
elongate  until  in  time  they  come  together.  The  mouth  is 
thus  permanently  propped  apart  in  front,  and  when  the 
second  molars  erupt  and  come  into  occlusion  the  ill-condi- 
tion is  confirmed.  With  these  eight  firm  teeth  in  contact, 
there  is  no  longer  any  hope  of  the  ten  anterior  ones  elon- 
gating sufficiently  to  meet,  and  we  have  the  deformity 
known  as  "lack  of  anterior  occlusion,"  which  is  not  only 
a  disfigurement,  but  a  serious  disadvantage  to  the  indvidual 
in  mastication  and  speech.  This  lack  of  anterior  occlusion 
is  not  always  due  to  the  habit  of  thumb-sucking,  for  it  may 
be  brought  about  by  physical  peculiarities,  as  noticed  in 
Part  III.,  Chapter  IX. 


ETIOLOGY. 


23 


Fig.  3. 


In  lip-sucking  the  lower  lip  is  drawn  into  the  mouth, 
over  the  lower  teeth  and  held  there  for  varying  periods 
both  day  and  night.  The  result  is  that  by  the  force  thus 
exerted  the  lower  teeth  are  thrown  inward  while  the  upper 
ones  are  forced  outward  to  such  an  extent  as  to  give 
them  unnatural  prominence  and  produce  spaces  between 
them. 

Fig.  3  illustrates  this  condition.  The  child  when  brought 
to  the  author  for  consultation,  was  eleven  years  of  age,  and 
a  confirmed  victim  to  the 
habit  of  lip-sucking.  Near- 
ly all  of  the  permanent 
teeth  in  each  jaw  were 
erupted  and  harmoniously 
related,  excepting  the  pro- 
trusion of  the  upper  and 
inward  inclination  of  the 
lower.      The    teeth    were  Result  of  up-sucking. 

brought  into  proper  position,  the  appearance  of  the  child 
greatly  improved,  and  the  habit,  by  being  made  impossible, 
was  broken  up. 

The  displacement  and  failure  of  occlusion  of  teeth  in 
the  anterior  part  of  the  mouth  are,  however,  not  the  only 
evils  associated  with  this  habit  in  its  three  forms.  In  each 
case  the  jaws  are  held  temporarily  apart  so  that  there  could 
be  no  occlusion  of  the  teeth  even  though  they  articulated 
normally  when  the  jaws  were  closed.  This  leaves  the  side 
teeth  free  to  change*  their  position  if  any  influence  is  exerted 
to  produce  that  result.  In  the  act  of  sucking,  the  cheeks 
are  drawn  in  and  the  strong  pressure  thus  brought  to  bear 
upon  the  bicuspids  and  (occasionally)  the  first  molars,  may 
cause  them  to  incline  inward.  In  this  malposition  they 
are  frequently  confirmed  by  the  opportunity  thus  given  the 
other  molar  teeth  to  move  forward,  of  wdiich  they  are  not 
slow  to  take  advantage. 


24  ORTHODONTIA. 

IRREGULAEITIES  OR  DEFORMITIES  WITH  MIXED  ETIOLOGICAL 
CHARACTERISTICS. 

There  are  some  typical  malformations  of  the  teeth  and 
jaws  the  cause  of  which  cannot  be  classed  under  either  the 
hereditary  or  the  acquired  form,  but  combine  certain  feat- 
ures of  both. 

Among  the  more  prominent  of  these  are  protrusion  of 
the  upper  teeth,  prognathism,  and  the  lancet  and  constricted 
arches. 

Superior  Protrusion. — In  this  condition  the  superior  ante- 
rior teeth  project  forward  and  outward  to  such  an  extent  as 
to  leave  a  space,  more  or  less  great,  between  their  cutting 
edges  and  those  of  the  lower,  thus  producing  a  marked 
deformity  and  giving  to  the  individual  a  slightly  imbecile 
expression.  The  lower  anterior  teeth,  when  the  jaws  are 
closed,  may  rest  in  contact  with  the  bases  of  the  superior 
ones,  or  they  may  impinge  upon  the  gum  tissue  adjacent. 

In  some  cases  this  deformity  is  but  the  expression  of  a 
tendency  inherited  from  a  progenitor  under  conditions 
favorable  to  reproduction,  while  in  others  it  may  be,  and 
doubtless  is,  the  result  of  mechanical  forces  finding  mani- 
festation in  the  individual  alone.  Even  if  inherited  it 
must  have  been  the  result  of  such  causes  in  the  individual 
with  whom  it  originated.  In  its  acquired  form,  this  abnor- 
mity may  be  caused  by  the  slow  eruption  of  the  j^osterior 
teeth,  which  by  failing  to  come  in  contact  for  a  long  time 
permit  of  an  unusually  long  over-bite  in  the  incisor  region. 
The  lower  incisors  thus  occluding  wifh  the  upper  ones 
near  their  base  have  a  tendency  to  force  the  latter  forward 
and  outward,  these  movements  being  favored  by  the  thin 
plate  of  alveolar  process  overlying  the  outer  surfaces  of 
their  roots.  As  the  upper  teeth  move  outward  .  the  lower 
ones,  from  lack  of  restraint,  elongate  until  their  incisal 
edges  occupy  a  plane  considerably  above  that  of  their 
fellows,  oftentimes  fitting  into  and  irritating  the  soft  tissues 
in  the  roof  of  the  mouth. 


ETIOLOGY. 


25 


The  same  result  is  sometimes  similarly  brought  about 
later  in  life,  when  through  loss  of  several  of  the  side  or 
back  teeth  the  burden  of  mastication  is  thrown  upon  the 
front  ones.  Lack  of  occlusion  posteriorly  and  excessive 
pressure  anteriorly  will  thus  produce  a  deformity  that  did 
not  exist  early  in  life. 

In  some  cases  it  may  also  be  caused  by  the  maleruption 
of  certain  of  the  jDOsterior  teeth,  permitting  them  to  assume 
positions  in  advance  of  or  posterior  to  their  normal  places ; 
such  a  condition  would  tend  to  restrain  the  lower  teeth  from 
pressing  forward,  and  cause  the  upper  ones  to  advance 
unnaturally. 

The  abnormity  appears  exaggerated  in  cases  where 
from  some  cause  the  lower  incisors  incline  inward,  thus 
causing  the  upper  ones  to  seem  more  protruded  than  they 
really  are. 

Inferior  Protrusion  or  Prognathism. — This  deformity,  con- 
sisting in  the  abnormal  protrusion  of  the  inferior  teeth  and 
jaw,  is  one  very  frequently  met  with.  It  gives  to  the  indi- 
vidual somewhat  of  a  canine  expression,  and  for  this  reason 
is  very  aptly  designated  by  the  Germans  as  "  Hundemaul." 
In  some  cases  the  lower  anterior  teeth  occlude  with  the 
superior  ones,  but  j^ass  outside  of  them,  while  in  others  the 
lower  jaw  and  teeth 
are  protruded  to  such 
an  extent  as  to  make 
the  occlusion  of  the 
lower  anterior  and 
side  teeth  with  those 
of  the  upper  jaw  a 
physical  impossibil- 
ity. Fig.  4  represents 
an  extreme  case  of 
this  character.     The  Prognathism, 

deformity  is  not  only  very  unsightly,  but  interferes  seriously 
with  mastication.     It  is  no  doubt  due  in  many  cases  to  arrest 


Fig.  4. 


26 


ORTHODONTIA. 


of  development  of  the  superior  arch,  and  is  favored  by  any 
cause  or  causes  that  tend  to  lessen  the  extent  of  contact 
in  occlusion.  That  the  lower  jaw  possesses  an  inherent 
tendency  to  move  forward  when  occlusion  does  not  prevent 
is  abundantly  shown  in  cases  where  the  individual  has  be- 
come edentulous  and  no  artificial  teeth  are  worn.  Even  the 
occlusion  of  artificial  teeth  will  lessen  or  check  this  tendency. 
In  many  cases  it  is  an  undoubted  inheritance,  while  in 
others  it  may  be  brought  about  by  local  conditions.  It  is 
liable  to  occur  in  all  cases  where  it  is  not  preA^ented  l)y 
mechanical  influences. 

Lancet  Arcli^. — The  angular  or  lancet  arch  is  not  an  un- 
common one.  In  a  typical  arch  of  this  character,  the  teeth 
instead  of  forming  a  rounded  arch,  are  arranged  in  two 
slightly  curved  and  convergent  lines,  which  meet  at  an  angle 
where  the  central  incisors  join  each  other.  The  molars,  bicus- 
pids and  cuspids  are  usually  properly  related  to  one  another, 
but  simj)ly  thrown  inward,  forming  nearly  straight  lines 
YiQ,,  5.  instead  of  jDOsitive  curves. 

The  incisors,  however,  by 
this  contraction  of  the  space 
are  not  only  thrown  for- 
ward, but  turned  upon  their 
axes  so  that  their  lingual 
surfaces  present  toward 
each  other.  Fig.  5  repre- 
sents this  form  of  irregular- 
ity. It  is  in  all  cases  con- 
fined to  the  superior  max- 
illa, the  lower  one  being- 
harmonious  in  outline. 
The  pressing  forward  of 
the  incisor  teeth  and  their  rotation  often  gives  such  promi- 
nence to  the  lip  that  the  teeth  remain  exposed  even  when 
the  jaws  are  closed.     In  addition  to  this  unsightliness,  the 


Lancet  Arch 


1.  See  "arch,"  Century  Dictionary. 


ETIOLOGY.  27 

speech  is  often  seriously  affected  by  the  free  and  uncon- 
trollable escape  of  air  when  articulation  is  attempted. 

The  causes  responsible  for  this  condition  are  probably 
shrouded  in  greater  obscurity  than  those  of  any  other  form 
of  irregularity. 

The  crowding  of  teeth  during  eruption,  delayed  eruption 
or  mal-occlusion,  some  of  which  are  evidently  resjDonsible 
for  many  forms  of  irregularity,  cannot  be  called  to  account 
for  this  condition,  for  none  of  them  could  press  the  teeth  into 
such  symmetrically  straight  lines.  Mr.  Charles  Tomes  be- 
lieves that  it  is  brought  about  by  the  pressure  of  the  muscles 
of  the  cheeks  upon  the  sides  of  the  arch  while  sleeping  with 
the  mouth  open,  and  that  this  habit  is  due  to  enlargement 
of  the  tonsils,  which  prevents  full  breathing  through  the 
nose. 

The  j)ressure  of  the  cheeks  covering  so  large  a  surface 
would  be  just  the  kind  of  force  likely  to  produce  this  sym- 
metrical contraction  of  the  arch,  but  we  are  confronted  with 
the  fact  that  in  mouth-breathing  the  jaws  are  never  held 
far  apart,  and  also  that  the  masseter  and  buccinator  mus- 
cles, owing  to  their  points  of  insertion,  stand  clear  of  the 
teeth,  so  that  even  when  somewhat  flexed,  they  could  not 
possibly  produce  pressure  upon  these  organs. 

The  condition  is  nearly  always  associated  with  a  high  and 
narrow  vault,  and  it  may  be  possible  that  both  of  these  fea- 
tures have  been  brought  about  by  imperfect  development  of 
adjacent  parts,  especially  of  the  vomer,  which  stands  in  the 
relation  of  a  pillar  or  support  to  the  palate. 

Constricted  Arch. — This  deformity,  though  less  common 
than  the  preceding  one,  and  giving  less  external  evidence 
of  its  existence,  is  far  more  likely  to  favor  decay  on  account 
of  increased  surface  contact.  In  seeking  an  explanation  for 
its  existence,  it  is  well  to  remember  that  the  bicuspid  teeth 
(the  ones  most  usually  affected)  are  situated  immediately 
beneath  the  deciduous  molars,  and  succeed  to  their  positions. 
As  the  first  set  occupies  an  arch  in  every  way  smaller  than 


28 


ORTHODONTIA. 


the  permanent  one,  the  position  of  the  bicuspids  would 
locate  them  inside  of  the  arch  described  by  the  permanent 
teeth  already  in  place.  When  there  is  no  obstacle  to  pre- 
vent, they  naturally  move  outward  into  place;  but  where 
insufficient  space  does  not  permit  this,  they  are  obliged  to 
remain  where  they  are,  or  in  an  effort  to  force  their  way  into 
line,  assume  a  crowded  and  irregular  position. 

The  fact  that  when  bicuspids  are  out  of  line  they  are 
nearly  always  found  to  be  inside  of  the  arch  seems  to  favor 
the  supposition  that  the  irregularity  has  been  brought  about 
in  the  manner  suggested.  Early  eruption  of  the  cuspids 
and  tardy  eruption  of  the  bicuspids  would  also  favor  the 
condition. 

The  assumption  that  bicuspids  once  in  line  may  be  forced 
out  of  it  by  pressure  exerted  in  the  eruption  of  the  second 
and  third  molars  has  little  to  support  it.     Were  this  possible 

or  probable  the  de- 
formity would  be 
more  frequently  met 
with.  Fig.  6  is  a  fair 
representation  of  this 
deformity.  Both  sides 
of  the  arch  are  not 
usually  affected  to  the 
same  extent,  and  in 
some  cases  the  two 
bicuspids  on  one  side 
occupy  a  position  di- 
rectly across  the  arch, 
each  one  being  partly 

Fig.  6. — Constricted  Arch  {Coleman).  turned  upon  its  axis. 

The  condition  is  rarely  met  with  in  the  lower  jaw,  and  is 
one,  according  to  the  author's  observation,  never  inherited, 
but  always  acquired. 


CHAPTER  III. 

EVILS  EESULTING  FEOM  IREEGULARITY. 

In  order  to  properly  appreciate  the  importance  of  cor- 
rection of  irregularity  of  the  teeth,  it  will  be  well  to  con- 
sider in  brief  detail  some  of  the  more  prominent  evils  asso- 
ciated with  the  condition. 

Appearance  Marred. — While  this  result  is  usually  not  the 
most  important  of  those  connected  with  irregularity,  it  is  the 
one  which  most  generally  induces  the  patient  to  apply  for 
remedial  treatment.  The  other  evils  may  not  be  recognized, 
or  may  be  considered  of  minor  importance  by  the  parent, 
but  the  ill-appearance  of  the  child  both  attracts  the  atten- 
tion and  enlists  the  sympathy  to  such  an  extent  as  to  create 
a  desire  for  its  improvement. 

The  external  deformity  caused  by  an  irregularity  will  be 
greater  or  less  according  to  its  extent  and  location.  If  it  be 
slight  in  character  and  located  back  of  the  cuspid  teeth,  it 
will  usually  give  no  external  evidence  of  its  existence,  but 
if  located  in  the  anterior  part  of  the  mouth,  it  will,  even  if 
slight,  be  very  noticeable  and  in  consequence  constitute  a 
source  of  annoyance  to  the  individual  throughout  life. 

The  class  of  irregularities  most  noticeable  under  all  con- 
ditions is  that  where  the  form  of  the  arch  is  altered,  thus 
changing  in  a  niarked  degree  the  entire  facial  expression. 
Such  deformity  cannot  be  masked.  It  must  either  be 
mechanically  reduced  or  stoically  endured. 

Speech  Affected. — This  result  like  the  preceding  one  will  be 
slight  or  aggravated  according  to  circumstances,  but  when 
at  all  considerable  it  proclaims  itself  to  the  world  with  every 
attempt  at  speech  in  so  unpleasant  a  manner  as  to  be  a 
painful  annoyance  to  both^'speaker  and  listener. 

29 


80  ORTHODONTIA. 

It  may  be  due  to  restriction  of  the  movements  of  the 
tongue  as  in  a  narrow  or  contracted  arch,  to  alteration  of 
the  form  of  the  roof  or  vault  of  the  mouth  where  the  sides 
of  the  latter  have  assumed  a  deep  pitch  resulting  in  the 
formation  of  a  sharp  angle  along  the  median  line  of  the 
palate,  or,  it  may  be,  and  most  usually  is,  due  to  the  uncon- 
trollable escape  of  air  between  the  teeth  in  the  anterior 
part  of  the  mouth  by  virtue  of  the  non-occlusion  of  those 
teeth  and  the  change  of  form  in  that  part  of  the  alveolar 
ridge  which  aids  the  tongue  in  the  production  of  perfect 
sounds. 

Mastication  Impaired. — In  most  cases  of  irregularity,  either 
simple  or  complicated,  there  is  a  corresponding  degree  of 
either  mal-occlusion  or  lack  of  occlusion.  In  simple  cases, 
or  where  but  few  teeth  are  thrown  out  of  occlusion,  it  may 
not  occasion  any  inconvenience  to  the  individual,  but  where 
the  irregularity  is  at  all  extensive  so  many  teeth  are  usually 
lacking  in  occlusion  as  to  seriously  impair  the  power  of 
mastication. 

When  this  latter  condition  prevails  it  is  most  likely  to 
result,  sooner  or  later,  in  injury  to  other  organs,  for  where 
mastication  is  imperfectly  performed  greater  demand  is 
made  uj)on  the  stomach  in  preparing  the  food  for  assimi- 
lation. The  stomach  soon  feels  the  effect  of  this  over-taxa- 
tion and  becomes  weakened  in  tone,  which  may  finally 
result  in-  incaj)acitating  it  for  the  performance  of  its  normal 
functions. 

Teeth  that  do  not  occlude  are  of  no  use  to  the  individual 
for  purposes  of  mastication,  and  those  that  occlude  but 
slightly  or  imperfectly  possess  very  slight  value. 

As  one  of  the  principal  functions  of  the  teeth  is  mastica- 
tion, and  as  all  the  teeth  are  needed  to  perform  this  work 
satisfactorily,  it  naturally  follows  that  any  interference  with 
this  function,  through  irregular  position  or  otherwise,  must 
be  detrimental  to  the  individual  and  may  result  in  partial 
or  complete  loss  of  health. 


EVILS    RESULTING    FROM    IRREGULARITY.  31 

Caries  Induced. — The  human  teeth  are  arranged  in  the 
jaws  in  such  manner  as  to  best  subserve  the  wants  of  the 
individual,  and  their  form  and  location  are  also  such  as 
to  conduce  to  greatest  immunity  from  caries  and  longest 
service. 

Their  rounded  approximal  surfaces  and  the  constriction 
of  their  necks  reduces  the  points  of  contact  with  their  fellows 
to  the  minimum.  As  their  liability  to  approximal  decay  is 
in  proportion  to  the  amount  of  surface  in  contact,  it  will  be 
seen  that  those  normally  placed  are  likely  to  be  freest  from 
the  ravages  of  caries. 

When,  therefore,  the  teeth  occupy  irregular  positions, 
especially  where  they  are  crowded,  more  of  the  surface  of 
each  tooth  is  in  contact,  and  the  liability  to  decay  is  corres- 
pondingly increased.  This  is  true  of  irregularly  placed 
teeth  in  any  part  of  the  arch,  but  the  liability  is  greater 
wdiere  crowding  or  overlapping  exists  among  the  incisor 
teeth,  for  owing  to  their  flattened  form  it  is  possible  for  more 
of  their  surfaces  to  be  in  contact  with  their  fellows  than 
would  be  possible  with  any  of  the  other  teeth.  In  such 
cases,  with  the  condition  uncorrected,  teeth  decay  and 
re-decay  in  spite  of  the  most  faithful  efforts  of  the  den- 
tist, until  they  are  finally  lost. 


CHAPTER  IV. 

ADVISABILITY  OF  CORRECTION. 

With  our  present  knowledge  in  regard  to  the  teeth  and 
their  surrounding  tissues,  and  the  advancement  made  of 
recent  years  in  the  multiplication  and  perfection  of  mechan- 
ical appliances,  scarcely  any  deformity  of  the  mouth  and 
teeth  is  beyond  mechanical  remedy.  With  possibility 
assured,  however,  it  is  most  important  that  we  should  con- 
sider carefully  the  question  of  advisability,  for  what  is  pos- 
sible may  not  always  be  advisable.  There  are  several  con- 
siderations that  enter  into  this  question  of  advisability. 

Age. — The  age  of  the  patient  has  much  to  do  with  tlie 
advisability  of  any  proposed  operation  for  correction.  Early 
in  life,  when  the  alveolar  tissues  have  not  yet  reached  tlie 
hardness  and  density  of  structure  which  they  will  attain  at 
a  later  period,  they  are  more  easily  operated  upon.  They  are 
elastic  and  readily  yield  to  pressure,  and  at  the  same  time 
under  the  influence  of  this  pressure  they  are  more  quickly 
resorbed  or  bent  and  thus  give  way  to  the  tooth  that  is 
being  moved.  This  feature  of  early  youth  is  an  important 
and  valuable  one  in  that  it  renders  an  operation  for  correc- 
tion more  easy  of  accomplishment,  but  while  the  soft  and 
easily  yielding  process  favors  the  operation,  it  is  at  the  same 
time  a  tissue  poorly  fitted  to  resist  the  influences  which  often 
operate  to  again  displace  the  tooth.  "  For  this  reason,  a  tooth 
moved  at  an  early  age  may  be  liable  to  subsequent  displace- 
ment when  the  pressure  caused  by  the  eruption  of  the  suc- 
ceeding teeth  is  brought  to  bear  upon  it. 

After  maturity  we  have  the  conditions  exactly  reversed. 
The  denser  and  more  perfectly  calcified  process  yields  less 
readily  to  pressure  and  resorption,  but  when  the  tooth  has 

32 


ADVISABILITY    OF    CORRECTION.  33 

once  been  moved  into  proper  position  it  is  more  easily  and 
firmly  held  there  by  the  surrounding  tissues. 

In  view  of  these  facts  it  will  readily  be  seen  that  in  many 
cases,  especially  where  the  proposed  operation  is  simple  in 
character  and  where  the  result  obtained  is  not  likely  to  be 
nullified  by  subsequent  events,  interference  early  in  life  is 
advisable ;  but  where  the  operation  is  to  be  extensive  in 
character,  and  especially  where  we  have  reason  to  doubt  our 
ability  to  retain  the  results  secured,  prudence  would  suggest 
non-interference  until  fourteen  teeth  of  the  involved  jaw 
have  erupted. 

Health. — The  health  and  strength  of  the  patient  at  the 
time  of  any  proposed  operation  for  irregularity  is  so  import- 
ant a  consideration  that  it  dare  not  be  disregarded.  The 
time  that  is  generally  considered  most  favorably  for  correc- 
tion (between  the  ages  of  twelve  and  eighteen  years)  is  also 
a  period  when  important  changes  are  going  on  in  the  entire 
economy.  The  individual  is  passing  from  the  stage  of  child- 
hood into  that  of  manhood  or  womanhood,  and  in  this 
change,  especially  in  the  case  of  the  female,  the  life-forces 
are  taxed  to  the  utmost.  At  this  time  also  the  mental  facul- 
ties are  being  severely  strained  by  study,  in  consequence  of 
which,  if  the  physical  culture  of  the  individual  be  neglected, 
as  it  too  often  is,  the  nervous  system  becomes  unduly 
exalted. 

To  meet  and  partially  compensate  for  these  drains  upon 
the  system  it  is  most  important  that  full  nutrition  be  sus- 
tained. To  do  this  with  teeth  that  are  sore  or  tender  to  the 
touch  from  being  moved  is  impossible,  and  hence  the  system 
will  be  still  further  weakened  by  lack  of  nourishment  if  any 
severe  operation  be  undertaken. 

At  this  period  of  life,  therefore,  unless  the  patient  pos- 
sesses vital  powers  of  a  high  order,  it  might  be  unwise  to 
further  tax  the  system  by  any  extensive  operation  for  cor- 
rection that  would  involve  the  infliction  of  much  pain, 
discomfort  or  annoyance.     Should  the  vitality  of  the  patient 


34  ORTHODONTIA. 

be  below  the  average,  no  difficult  or  protracted  operation  for 
correction  should  be  undertaken,  for  it  might  result  in  per- 
manent impairment  of  the  health. 

It  is  much  better  to  postpone  the  operation  until  a  time 
when  the  vital  powers  can  stand  the  strain  or  if  necessary 
abandon  it  altogether,  for  the  loss  of  health  can  never  be 
compensated  for  by  any  benefit  conferred  upon  the  dental 
organs. 

Sex. — The  sex  of  the  individual  must  also  be  considered 
in  connection  with  this  subject.  The  consideration  of  sex 
may  be  disregarded  so  far  as  the  desirability  of  an  operation 
is  concerned — for  if  the  results  of  neglected  irregularity  are 
harmful  in  respect  to  one  sex,  they  are  certainly  equally  so 
in  regard  to  the  other — but  as  regards  the  necessity  for  inter- 
ference the  question  of  sex  is  an  important  one.  Correct 
facial  expression  and  harmony  of  feature  are  far  more  im- 
portant to  woman  than  to  man ;  for,  being  endowed  by 
nature  with  greater  beauty  of  form  and  feature,  its  absence 
in  an}^  part  is  more  noticeable  than  it  would  be  in  the 
sterner  sex.  Besides  this,  after  youth  is  passed,  man  has 
in  the  hairy  covering  of  the  lip  a  means  of  concealing 
most  deformities  of  the  dental  arch,  while  woman  is  entirely 
without  this  advantage.  For  these  reasons  the  necessity 
for  the  correction  of  any  irregularity  of  the  teeth  seems 
more  imperative  in  woman  than  in  man. 

Power  of  Appreciation. — The  intelligence  of  the  patient 
and  his  ability  to  properly  apjDreciate  any  benefit  conferred, 
are  important  considerations  in  enabling  us  to  determine 
whether  or  not  to  undertake  any  considerable  operation  for 
the  correction  of  irregularity.  At  best  it  is  a  most  difficult 
undertaking,  and  frequently  lacking  in  suitable  pecuniary 
reward,  so  that  the  lover  of  the  art  must  nearly  always 
depend  upon  appreciation  for  part  of  his  compensation. 
If  this  be  wanting,  the  operation  is  robbed  of  nearly  or 
quite  all  of  its  attractiveness,  and  the  stimulus  to  success 
is  absent. 


ADVISABILITY    OF    CORRECTION.  35 

There  are  those  whose  want  of  inteUigence  or  lack  of  cul- 
ture would  lead  them  to  regard  with  much  indifference  any 
irregularity  of  their  teeth,  and  who  if  benefited  by  our 
efforts  for  correction  would  fail  to  appreciate  it.  For  such 
manifestly  it  would  be  unwise  to  urge  or  encourage  any  diffi- 
cult or  extensive  operation  for  correction  even  though  they 
might  be  able  to  compensate  us  pecuniarily  for  our  labor, 
for  they  would  be  likely  either  to  abandon  the  operation 
when  partially  completed  or  fail  to  wear  any  appliance  for 
retention,  and  thus  permit  failure  to  follow  success. 

Family  Type. — When  any  great  deformity  of  the  teeth 
and  jaws,  such  as  anterior  j^rotrusion  of  either  jaw  or  a 
lancet  arch  is  shown  to  be  hereditary,  it  is  well  to  take  into 
consideration  this  feature  of  the  case  before  beginning 
any  operation  for  correction.  Where  the  irregularity  is 
known  to  have  been  acquired  in  the  parent  of  the  child 
and  thus  to  have  been  transmitted  but  once,  the  difficulties 
in  the  case  are  not  so  marked  because  the  type  has  scarcely 
been  confirmed ;  but  where  it  has  been  transmitted  through 
two  or  more  generations  the  impress  is  strong  and  difficult 
to  overcome. 

In  the  latter  case  the  correction  of  the  deformity  will  not 
be  more  difficult  than  usual,  but  after  correction  the  ten- 
dency of  perverted  nature  to  cause  a  return  to  the  family 
type  will  be  so  strong  as  to  almost  baffle  us  in  our  attempts 
to  preserve  the  advantage  we  have  gained.  Under  such  cir- 
cumstances the  retaining  appliance  will  have  to  be  worn  a 
very  long  time,  and  a  constant  watch  kept  over  the  case 
until  we  are  sure  that  the  result  will  be  permanent. 

Improvement  of  Occlusion. — Faulty  occlusion  is  always 
necessarily  associated  with  irregularity  and  is  one  of  its  most 
objectionable  features.  While  mastication  may  be  per- 
formed to  the  satisfaction  of  the  individual  where  an  irregu- 
larity exists,  it  can  neither  approach  the  ideal  of  nature  nor 
properly  subserve  its  own  ends  unless  the  teeth  occlude  in  a 
normal  manner.     It  would  be  difiicult  to  find  a  set  of  teeth 


36  ORTHODONTIA. 

in  which  the  occlusion  is  all  that  could  be  desired,  but  the 
nearest  approach  to  it  is  what  we  should  strive  after.  There- 
fore, in  considering  the  advisability  of  correction  in  any 
given  case,  we  should  carefully  study  the  existing  conditions 
and  endeavor  to  ascertain  in  advance  whether,  when  we 
have  improved  the  arrangement  of  the  teeth,  we  have  also 
improved  the  articulation. 

Dr.  Davenport  says :  *  "  In  the  treatment  of  our  patients, 
it  is  hoped  that  if  we  cannot  all  see  our  way  clearly  upon 
this  matter,  we  may  at  least  see  far  enough  not  to  make  the 
occlusion  worse  by  our  operations  than  they  were  when 
brought  to  us." 

"  Much  harm  is  done  by  the  use  of  regulating  appliances 
which  change  the  occlusion  without  improving  it,  and  it 
is  almost  a  universal  fact  that  unless  an  improvement  can 
be  made  in  the  occlusion,  there  will  be  no  permanent  im- 
provement in  the  irregularity." 


*  International  Dental  Journal,  Jan.,  '92. 


CHAPTER  V. 

AGE  AT  WHICH  CORRECTION  MAY  BE  BEGUN. 

The  correction  of  irregularities,  under  favoring  condi- 
tions, may  be  begun  and  carried  forward  successfully 
through  a  wide  range  of  years. 

It  may  be  undertaken  as  early  as  the  eighth  or  ninth  year, 
and  again  may  yield  successful  results  as  late  as  the  thirty- 
fifth  year  or  later.  The  operation  is  one  largely  dependent 
upon  the  resorption  and  reformation  of  alveolar  tissue,  and 
as  new  bone  will  form  at  almost  any  period  of  life,  as  evi- 
denced by  the  union  of  a  fracture,  so  the  correction  of  an 
irregularity  is  possible  at  quite  a  late  period. 

The  oj^eration,  however,  would  usually  prove  so  slow 
and  tedious  after  the  maximum  of  density  has  been 
attained  in  the  alveolus,  and  the  necessity  for  it  be  so 
much  lessened  by  advancing  age,  that  the  advisability  of 
undertaking  it  would  be  questionable. 

When  Early  Interference  is  Justifiable  and  Advisable. — Any 
of  the  permanent  teeth  may  erupt  outside  or  inside  of  the 
arch.  If  allowed  to  remain  in  such  position  for  any  length 
of  time,  the  space  intended  for  their  accommodation  will 
soon  be  partly  occupied  by  the  adjoining  teeth,  and  the  sub- 
sequent correction  of  the  irregularity  rendered  more  diffi- 
cult. A  central  or  lateral  incisor  often  erupts  in  such  a 
manner  that  its  incisal  edge,  instead  of  being  in  line  with 
the  curve  of  the  arch,  forms  an  angle  with  it. 

This  torsion  may  be  associated  with  an  overlapping  of  the 
adjacent  tooth  as  shown  in  Fig  7,  or  there  may  be  a  space 
between  the  two  as  shown  in  Fig.  8. 

In  either  case  the  turned  tooth  occupies  a  less  space  in 
the  line  of  the  arch  than  it  should.     By  allowing  this  con- 

37 


38 


ORTHODONTIA. 


Torsion  and  Overlapping 

Fig.  8. 


dition  to  remain,  when  the  pressure  of  the  later  erupting 
teeth  begins  to  be  felt,  these  teeth  will  be  pressed  still  closer 
together  and  the  irregularity  be  con-  pj(j  -7 

firmed.  Subsequently,  when  the  cor- 
rection of  the  condition  is  attempted, 
there  will  not  be  sufficient  room  to 
accommodate  the  tooth  in  its  wider 
aspect  and  the  adjoining  teeth  will 
have  to  be  pressed  apart  or  the  arch 
expanded  to  obtain  the  necessary 
room ;  whereas,  if  the  tooth  had  been 
turned  in  its  socket  before  the  erup- 
tion of  the  other  teeth  the  operation  Torsion  witti  spacf. 
would  have  been  a  very  simple  one. 

Again,  when  an  incisor  erupts  so  as  to  occupy  a  position 
inside  of  the  line  of  the  arch  in  the  upper  jaw,  or  outside  of 
it  in  the  lower,  and  the  tooth  be  held  in  such  position  by 
the  opposing  teeth,  immediate  interference  and  correction 
is  demanded  in  order  to  prevent  the  complications  that 
would  result  from  the  partial  or  complete  closure  of  the 
space  intended  for  the  accommodation  of  the  malposed  tooth. 

Fig.  9  shows  a  case  of 
this  character  with  both 
laterals  inlocked.  The 
superior  central  incisors 
sometimes  erupt  with 
their  incisal  edges  form- 
ing an  angle  at  the  me- 
dian line.  To  neglect 
the  condition  or  to  post- 
pone its  correction  would 
not  only  result  in  its 
confirmation  and  prob- 
able aggravation,  but 
might  also  open  the  way  for  a  complete  change  in  the  shape 
of  the  arch.     Fig.  10  illustrates  this  condition. 


Inlocked  Laterals. 


AGE    FOR    CORRECTION.  39 

It  is  entirely  jDrobable  tliat  certain  arches  of  a  modified 
lancet  shape  have  been  formed  in  this  way.  In  cases  such  as 
those  just  mentioned,  early  interference  is  the  wiser  plan,  but 
it  is  equally  important  that  after  the  teeth  have  been  placed 
properly  in  line  they  should  be  firmly  held,  not  only  until 
new  bony  tissue  has  been  formed  Fig.  lo. 

around  them,  but  until  the  lateral 
pressure  of  the  neighboring  teeth 
coming  into  place  has  spent  itself 

In  the  lower  jaw  the  conditions 
are  somewhat  dififerent.  The  inci- 
sors, upon    eruption,   generally   as-  Torsion  of  both  CentralsT 

sume  a  somewhat  crowded  and  irregular  position,  which  is 
partly  or  entirely  corrected  by  nature  in  the  enlargement  of 
the  arch  and  the  influence  of  the  lip  and  tongue  in  bringing 
them  into  a  more  harmonious  outline. 

Interference  with  them  when  they  are  within  the  arch 
is  not  usually  called  for  until  a  later  period. 

While  there  are  many  practitioners  who  have  long  held 
the  view  that  early  interference  is  inadvisable  in  the  great 
majority  of  cases,  the  large  experience  of  others  who  have 
made  a  specialty  of  this  branch  of  practice  has  led  them  to 
declare  in  favor  of  early  correction.* 


*  ''As  soon  after  eruption  as  it  becomes  certain  that  an  irregular  denture 
is  inevitable,  there  is  no  longer  justification  for  delay,  and  after  that  period 
every  year  increases  the  difficulties,  both  mechanical  and  pathological,  and 
prejudices  the  stability  of  the  dental  apparatus.  .  .  .  The  author  has 
not  hesitated  to  undertake  treatment  of  very  extensive  irregularities,  even 
vs^hile  teeth  were  emerging  from  the  gums." — Kingsley — Oral  Deformities, 
pp.  61,  62. 

"It  is  the  opinion  of  the  writer  that  each  tooth  should  be  encouraged  to 
take  a  correct  position  in  the  circle  of  the  arch  while  erupting  ( or  as  soon 
thereafter  as  practicable),  in  order  to  promote  the  proper  development  of  the 
jaw,  for  the  teeth  next  to  be  erupted  are  thus  more  likely  to  do  so  in  proper 
position  and  order." — Jackson — Trans.  Amer.  Dent.  Assoc,  1890,  p.  201. 

"  I  believe  the  best  time  to  begin  the  treatment  is  as  soon  as  the  appear- 
ances of  irregularity  are  manifest,  then,  with  delicate  and  simple  appliances, 


40  ORTHODONTIA. 

Certainly  where  the  case  is  brought  to  our  attention  in 
its  incipiency  we  can  frequently  by  judicious  management 
and  the  application  of  slight  corrective  measures  either 
counteract  or  greatly  modify  any  tendency  toward  irregu- 
larity. 

A  feature  favoring  early  correction  is  that  the  roots  of  the 
teeth  are  not  fully  calcified  until  a  long  time  after  their 
eruption.  Until  fully  calcified  the  apical  foramina  are 
large  and  more  than  accommodate  the  nutrient  vessels 
entering  the  tooth,  so  that  there  is  less  danger  of  devitaliz- 
ing the  pulp  through  strangulation  in  the  movement  of  a 
tooth  at  this  period  than  later. 

When  Correction  Should  be  Delayed  Until  Dentition  is 
Complete. — In  some  cases  an  extensive  ojDeration  for  the  cor- 
rection of  irregularity  involving  a  number  of  teeth  should 
not  be  undertaken  until  all  of  the  permanent  teeth  (except- 
ing the  third  molars)  are  fully  erupted.  When  but  a  few  teeth 
are  malj^osed  with  no  prospect  of  their  being  able  to  take 
their  places  in  the  arch  unaided,  and  every  prospect  of  their 
being  confirmed  in  their  malposition,  the  necessity  for 
immediate  interference  is  plainly  evident ;  but  where  a  large 
number  of  teeth  are  malposed  it  is  not  so  easy  to  prognosti- 
cate what  efi'ect  their  correction  may  have  when  considered 
in  relation  to  the  teeth  still  to  be  erupted.     The  result  is 

gradually  assist  the  tooth  to  take  its  natural  position.  ...  A  few  days 
with  a  proper  appliance  will  often  accomplish  what  may  require  many 
months  if  left  until  the  whole  dental  apparatus  is  involved." — Angle — Pam- 
phlet, p.  50. 

' '  Early  interference  is  often  necessary,  as  where  the  superior  incisors 
erupt  slightly  posterior  to  their  natural  position  and  occlude  with  the  cut- 
ting edges  of  the  lower  ones.  Should  the  superior  incisors  not  be  moved 
forward  as  soon  as  this  tendency  is  noticed  permanent  prognathism  might 
result.  Correction  should  be  commenced  as  soon  as  appliances  can  be  used 
to  advantage. ' ' — Goddard — MSS. 

"As  soon  as  a  tooth  (or  a  number  of  teeth)  erupting  show  such  misplace- 
ment that  natural  conditions  will  not  make  it  self-correcting,  mechanical 
means  should  at  once  be  resorted  to— no  matter  what  the  age.  The  only 
condition  that  would  not  justify  such  interference  is  ill-health." — Mat- 
teson— MSS. 


AGE    FOR    CORRECTION.  41 

naturally  involved  in  some  doubt.  Even  if  the  necessity 
for  correction  appears  evident  to  us  and  we  should  accom- 
plish it,  the  final  result  may  not  be  all  that  we  had  hoped 
for. 

Under  such  circumstances  it  is  wise  to  delay  interference 
until  the  permanent  teeth  are  in  place  and  the  arch  fully 
expanded,  when  by  a  careful  examination  of  all  the  condi- 
tions we  can  easily  foresee  the  result  of  any  proposed  opera- 
tion and  decide  intelligently  not  only  what  needs  to  be  done, 
but  also  the  best  way  of  accomplishing  the  desired  result. 
Oftentimes  this  later  examination  will  show  that  the  irregu- 
larity has  much  improved  and  the  necessity  for  interference 
is  consequently  lessened. 

The  line  of  distinction  between  the  advisability  of  early 
and  late  interference  is  not  always  plainly  marked,  but 
where  there  is  no  very  evident  reason  for  delay  prompt 
interference  is  the  safer  and  better  plan. 


CHAPTER  Aa. 

EXTRACTION  AS  RELATED  TO  ORTHODONTIA. 

Probably  no  operation  in  the  jDractice  of  Orthodontia  is 
more  imjDortant,  or  has  associated  with  it  greater  possibilities 
•for  good  or  evil  to  the  patient  than  that  of  extraction. 

As  related  to  the  prevention  or  correction  of  irregularity, 
extraction  on  the  one  hand  may  be  of  the  greatest  possible 
benefit  or  on  the  other  it  may  result  in  irreparable  injury. 

Judicious  extraction,  if  undertaken  in  time,  will  often 
forestall  or  prevent  an  irregular  condition  of  the  teeth,  and 
in  other  cases  it  will  assist  greatly  in  simplifying  the  opera- 
tion of  correction.  Occasionally,  it  is  all  that  is  called  for 
on  our  part,  nature  performing  the  rest  of  the  operation 
unaided. 

Injudicious  or  ill-advised  extraction,  however,  may  com- 
plicate and  render  most  difficult  the  correction  of  cases 
which  in  themselves  were  not  difficult,  or  it  may  even  be 
the  immediate  cause  of  a  deformity  which  would  not  other- 
wise have  existed. 

The  paramount  importance,  therefore,  of  knowing  when 
to  extract,  and  when  not,  will  be  readily  recognized. 

In  order  to  give  the  student  a  fair  idea  of  the  determining 
conditions  in  as  concise  and  comjDrehensive  a  manner  as 
possible,  it  has  been  thought  best  to  formulate  the  following 
rules : 

Rule  I. — Avoid,  if  possible,  extraciing  any  of  the  six  anterior 
teeth  in  the  superior  arch. 

We  would  urge  this,  because  it  is  nearly  always  unneces- 
sary to  extract  them,  and  because  their  absence,  owing  to 

42 


EXTRACTION  AS  RELATED  TO  ORTHODONTIA.      43 

their  prominent  position,  would  be  more  noticeable  than 
that  of  other  teeth  in  the  mouth.  If  the  anterior  teeth 
be  sound  and  only  irregular,  the  extraction  of  a  bicuspid 
from  one  or  both  sides  will  usually  give  us  sufficient  room 
for  spreading  the  anterior  teeth  and  moving  them  into  their 
proper  positions. 

It  has  happened,  however,  to  the  author  and  others,  to 
meet  with  cases  where  the  superior  laterals  were  locked 
inside  the  arch  by  the  close  approximation  of  centrals  and 
cuspids,  and  where  the  laterals  were  withal  so  badly  injured 
by  decay  and  disease  as  to  render  their  usefulness  doubtful 
if  brought  into  line.  In  such  few  cases  it  was  deemed  best 
to  extract  the  laterals,  especially  as  their  absence  would  not 
be  more  noticeable  afterward  than  before,  and  because  there 
was  good  occlusion  between  the  rest  of  the  teeth  in  the 
mouth. 

The  author  had  two  unusual  cases  present  to  him  in  one 
year  for  the  reduction  of  protrusion  of  the  superior  anterior 
teeth.  In  each  case  there  was  a  broken  or  badly  diseased 
right  central  incisor  that  was  beyond  hope  of  preservation. 
In  these  cases  it  did  not  happen  particularly  amiss,  for  the 
extraction  of  the  roots  afforded  room  for  drawing  in  the 
remaining  five  teeth,  thus  easily  reducing  the  deformity  and 
at  the  same  time  closing  the  space.  The  appearance  of  the 
patient  in  each  instance  was  greatly  improved,  and  the 
absence  of  even  so  large  a  tooth  as  the  central  was  scarcely 
noticeable. 

It  must  be  borne  in  mind  that  in  the  cases  just  mentioned 
advantage  was  simply  taken  of  an  existing  condition  to 
simplify  an  operation.  Had  the  teeth  been  good,  the  proper 
plan  to  pursue  would  have  been  to  extract  a  bicuspid  on 
each  side  and  retract  the  anterior  teeth. 

In  another  case,  a  girl  eleven  years  of  age  had  lost  a  supe- 
rior right  central  incisor  through  a  fall  from  a  swing.  Two 
days  after  the  accident,  and  when  the  tooth  had  been  mis- 
laid or  thrown  away,  she  was  brought  for  treatment.     Only 


44  ORTHODONTIA. 

two  methods  of  remedying  the  difficulty  suggested  them-  ' 
selves.  One  was  the  wearing  of  an  artificial  tooth ;  the 
other,  drawing  the  teeth  together  to  close  the  space.  The 
latter  plan  was  decided  upon,  and  successfully  carried  into 
effect ;  but,  unfortunately,  as  there  had  been  no  protrusion 
before  and  there  was  contraction  afterward,  the  superior 
teeth  no  longer  overlapped  the  lower  ones,  but  met  them 
edge  to  edge,  thus  giving  the  upper  jaw  a  flattened  appear- 
ance, which  was  in  itself  a  deformity.  The  patient  was 
saved  the  annoyance  of  wearing  a  plate,  but  her  facial 
expression  was  injured  in  consequence. 

Such  cases  as  those  just  described  are  exceedingly  rare, 
and  are  only  mentioned  as  extraordinary  exceptions  to  a 
very  good  rule.  Aside  from  the  centrals,  there  is  probably 
less  excuse  for  the  extraction  of  the  cuspids,  than  any  of 
the  anterior  teeth,  and  yet  it  is,  unfortunately,  too  often 
resorted  to. 

If  for  any  cause  the  cuspids  erupt  abnormally,  and  there 
is  no  room  for  them  in  the  arch,  if  it  be  not  advisable  to 
expand  the  arch,  one  of  the  teeth  on  each  side  should  be 
extracted  to  make  room  for  them. 

The  decision  as  to  which  tooth  to  extract  (where  extraction 
is  deemed  best)  in  order  to  allow  an  outstanding  cuspid  to 
be  brought  into  line  will  be  largely  governed  by  the  position 
that  this  tooth  occupies.  If  it  be  situated  in  a  line  between 
the  lateral  and  first  bicuspids  with  its  root  sloping  back- 
ward, the  bicuspid  would  be  the  proper  tooth  to  extract.  If, 
however,  the  slant  of  the  root  be  forward  the  lateral  incisor 
should  be  removed,  because  in  drawing  the  crown  of  the 
cuspid  forward  to  occupy  the  place  of  the  lateral,  it  would 
be  made  to  occupy  a  more  nearly  vertical  and  normal  posi- 
tion. To  move  the  crown  of  a  cuspid  forward  when  it 
already  inclines  forward,  or  backward  when  it  points  that 
way,  would  cause  it  to  present  such  an  oblique  appearance 
as  to  be  very  unsightly. 


EXTRACTION  AS  RELATED  TO  ORTHODONTIA.      45 

Rule  II. — In  the  lower  jaw  one  of  the  incisors  may  sometimes 
he  extracted  to  gain  space. 

Slight  irregularity  or  crowding  of  the  inferior  incisors  is 
of  such  common  occurrence  as  to  have  almost  become  the 
rule  instead  of  the  exception.  Their  partial  concealment, 
together  with  the  usual  freedom  of  the  condition  from  ill 
results,  causes  any  interference  to  seem  meddlesome  rather 
than  otherwise,  if  the  irregularity  be  trifling.  In  cases, 
however,  where  the  crowding  is  excessive  and  calls  for  cor- 
rection, it  is  usually  the  easier  and  better  plan  to  extract 
one  of  the  implicated  teeth  and  bring  the  others  together 
into  line.  The  four  teeth  are  so  nearly  alike  in  size  and 
appearance,  that  when  one  has  been  removed  the  loss  is  not 
usually  noticed.  It  is  sometimes  perplexing  to  decide  which 
of  the  four  to  extract,  but  the  one  most  out  of  line,  and  in 
consequence  the  one  which  will  create  the  least  space  by  its 
removal,  should  usually  be  selected. 

In  respect  to  the  loss  of  the  inferior  cuspid,  the  same 
remarks  apply  as  to  its  fellow  in  the  opposite  jaw. 

Rule  III. — Back  of  the  anterior  teeth,  if  all  are  equally  good 

and  one  must  be  removed,  select  the  one  nearest  and 

posterior  to  the  one  out  of  position. 

As  so  large  a  proportion  of  the  irregularities  we  are  called 
upon  to  correct  pertain  to  the  anterior  teeth,  and  as  it  is  so 
important  to  retain  these,  extraction  for  room,  when  neces- 
sary, generally  falls  upon  one  of  the  teeth  posterior  to  the 
cuspids.  Which  of  these  it  is  best  to  extract,  to  make  room 
for  a  malposed  cuspid  or  incisor,  has  been  a  subject  of  con- 
troversy among  practitioners  for  many  years. 

Some  have  claimed  that  as  the  statistical  tables  show  the 
first  molar  to  be  by  far  the  least  durable  of  all  the  perma- 
nent teeth,  it  should  generally  be  selected  as  the  one  to  be 
sacrificed.  Others,  on  the  contrary,  have  contended  that  as 
the  first  and  second  bicuspids  are  both  frail  teeth,  and  are 


46  ORTHODONTIA. 

often  lost  early  in  life,  and  as  from  its  greater  size  the  first 
molar  is  so  much  more  valuable  in  mastication,  it  should  be 
preserved  and  one  of  the  bicuspids  removed. 

There  is  truth  in  both  of  these  arguments,  but  we  feel 
satisfied  that  under  the  conditions  named,  (all  equally  good 
at  the  time,)  wisdom  will  dictate  the  removal  of  the  one 
nearest  the  point  of  difficulty,  for  in  so  doing  we  greatly 
simjDlify  the  operation  for  correction  and  effect  a  saving  all 
around.  Simplicity  in  surgical  as  well  as  mechanical  mat- 
ters is  a  great  desideratum.  Indeed,  it  not  infrequently 
happens  that  where  a  cuspid  is  out  of  line  the  first  bicuspid 
has  usurped  its  place  in  the  arch,  so  that  if  we  were  to 
extract  the  first  molar,  both  first  and  second  bicuspids 
would  have  to  be  moved  out  of  their  positions  of  good  occlu- 
sion into  a  space  farther  back,  a  feat  very  difficult  and 
oftentimes  well-nigh  impossible  of  accomplishment.  By  the 
simple  extraction  of  the  first  bicuspid  in  such  cases,  the 
cuspid  will  usually  fall  into  its  place  without  any  assistance. 

In  certain  cases  where  there  is  nearly  but  not  quite  suffi- 
cient sj)ace  in  the  arch  to  accommodate  an  outstanding 
cuspid,  and  where  the  occlusion  would  not  contra-indicate 
such  action,  it  is  better  to  extract  the  second  bicuspid  instead 
of  the  first,  because  the  surplus  space  thus  created  will  then 
be  back  of  the  first  bicuspid,  and  consequently  less  notice- 
able than  it  would  be  in  front. 

Rule  IV. — If  a  tooth  other  than  the  one  nearest  to  that  in  mal- 
position be  defective,  and  not  too  far  distant  from 
point  of  irregularity,  extract  it  instead. 

The  second  molar,  decayed  or  sound,  is  usually  too  far 
distant  to  be  available  by  its  extraction  in  furnishing  room 
for  the  movement  of  anterior  teeth.  If  the  bicuspids  be 
sound  and  the  occlusion  does  not  interfere  with  their  back- 
ward movement,  the  first  molar,  if  very  defective,  may  be 
extracted  in  preference  to  a  sound  tooth  in  advance  of  it. 


EXTRACTION  AS  RELATED  TO  ORTHODONTIA.      47 

If  the  second  bicuspid  be  badly  diseased  and  the  first  one 
healthy,  the  former  may  be  extracted  instead. 

With  our  present  methods  of  restoration,  however,  it  will 
seldom  be  necessary  to  condemn  and  extract  any  tooth  on 
account  of  extensive  caries,  for  by  proper  crowning,  it  can 
be  restored  to  usefulness  for  a  great  number  of  years. 

Rule  V. — If  a  tooth  must  be  lost,  either  to  allow  a  TYhore  import- 
ant one  to  fall  into  line  or  to  create  space,  it  should  be 
done  without  delay  to  accomplish  the  best  results. 

When  a  cuspid  erupts  without  room  in  the  arch  for  its 
accommodation,  and  the  circumstances  of  the  case  point  to 
the  extraction  of  the  first  bicuspid  to  make  place  for  it,  the 
sooner  the  extraction  takes  place  the  better.  If  the  opera- 
tion be  delayed,  the  cuspid  in  its  endeavor  to  force  its  way 
into  place  will  often  press  so  hard  upon  the  lateral  as  to 
force  it  inward  and  if  possible  under  the  central,  thus 
creating  an  additional  irregularity.  Such  results  have  often 
been  noticed.  Prompt  extraction  after  it  had  become  neces- 
sary would  have  changed  the  condition. 

In  similar  manner,  when  it  becomes  advisable  to  extract 
one  or  more  of  the  first  molars  to  prevent  the  further  expan- 
sion of  the  jaw  or  to  abort  a  threatened  irregularity  in  the 
anterior  part  of  the  arch,  it  is 'best  not  to  delay  their  extrac- 
tion too  long.  They  should  not  be  extracted  before  the 
second  bicuspids  are  in  place,  but  if  they  must  be  lost,  they 
should  be  removed  after  the  eruption  of  the  latter  teeth  and 
before  the  second  molars  appear,  somewhere  about  the 
•eleventh  or  twelfth  year.  If  longer  delayed  the  harm  we 
wished  to  prevent  (expansion  of  the  jaw)  will  have  been 
accomplished  and  their  later  extraction  will  not  avail.  If 
extracted  about  the  time  the  second  molars  are  erupting,  the 
latter  will  naturally  glide  into  the  space  formerly  occupied 
by  the  extracted  teeth ;  this  they  are  not  so  apt  to  do  later. 


48  ORTHODONTIA. 

Rule  VI. — If  a  tooth  must  be  removed  on  one  side  to  obtain 

space  it  does  not  follow  that  its  mate  on  the  opposite 

side  should  also  be  extracted. 

If  there  be  the  same  reason  for  extracting  both,  as  where 
the  existmg  evil  pertains  as  much  to  one  side  as  to  the 
otlier,  let  both  be  extracted ;  but  where  the  trouble  sought  to 
be  remedied  is  confined  to  one  side,  the  extraction  of  a  tooth 
on  that  side  ought  not  to  be  supplemented  by  a  useless 
extraction  on  the  other.  Those  who  favor  symmetrical  or 
double  extraction  claim  that  it  prevents  the  disturbance  of 
the  median  line,  but  it  has  been  our  experience  that  the 
extraction  of  a  tooth  back  of  the  cus2Did  will  not  often  affect 
the  central  line  through  the  moving  of  the  teeth  toward  the 
space,  and  even  a  slight  disturbance  of  that  line  is  far  less 
objectionable  than  the  sacrifice  of  a  valuable  tooth.  A  cor- 
respondent mentions  a  case  in  which,  after  a  long  struggle 
to  save  the  badly  decayed  superior  first  molars  of  a  Miss, 
14  years  of  age,  he  determined  to  extract  them.  After  three 
months  the  girl  returned,  and  it  was  noticed  that  the  supe- 
rior centrals  had  separated  one-eighth  of  an  inch.  He  adds, 
"  since  that  time  I  have  refused  to  extract  symmetrically 
in  growing  subjects." 

Rule  VII. —  Where  there  is  disparity  in  size  between  the  two 

jaws,  and  two  teeth  need  to  be  extracted  from  the  more 

prominent  one,  it  ivould  be  a  serious  mistake  to 

extract  the  corresponding  teeth  in  the 

other  and  smaller  jaw. 

It  would  seem  almost  impossible  to  make  such  a  mistake 
and  yet  that  it  has  been  made  time  and  again,  the  mouths 
we  are  called  upon  to  examine  often  bear  sad  evidence.  It 
occurs  through  lack  of  knowledge,  want  of  judgment,  or 
erroneous  teaching. 

When  those  of  long  practice  advise,  without  qualification, 


EXTRACTION  AS  RELATED  TO  ORTHODONTIA.      49 

that  at  eleven  years  of  age  the  four  first  molars  should  be 
extracted,  it  is  scarcely  to  be  wondered  at  that  some  young 
practitioners  should  lose  confidence  in  their  own  better 
judgment  and  be  led  astray.  Harm  of  this  nature,  when 
once  done,  can  never  be  undone,  and  the  patient  is  injured 
beyond  remedy. 

Rule  VIII. — Needless  extraction  should  be  carefully  guarded 

against. 

It  is  our  object  to  save  and  improve,  not  to  destroy. 
Extraction  should  only  be  resorted  to  when  it  appears,  after 
careful  consideration,  to  be  the  best  or  only  way  of  accom- 
jDlishing  the  object  in  view.  Ill-advised  extraction  of  the 
molars  or  bicuspids  has  often  been  the  cause  of  a  very 
serious  and  irremediable  form  of  deformity,  namely : — the 
separation  of  the  anterior  teeth,  leaving  unsightly  spaces 
between  them,  thus  depriving  them  of  natural  support  and 
leading  to  their  earlier  loss. 

When  teeth,  especially  the  first  molars,  are  extracted  at  a 
later  period  than  they  should  be,  leaving  a  space  that  the 
second  molars  cannot  occupy,  the  teeth  anterior  to  the  space 
will  fall  back  unless  prevented  by  the  occlusion.  If  this 
falling  back  pertains  only  to  the  bicuspids,  no  harm  will 
usually  result,  but  if  it  extends  to  the  anterior  teeth,  as  it 
may,  and  often  does,  the  result  will  be  disastrous.  In  this 
connection  we  cannot  help  again  emphasizing  the  necessity 
for  the  removal  of  first  molars  (if  they  are  to  be  removed) 
before  the  second  molars  have  assumed  their  place  in 
the  arch. 


CHAPTER  VII. 

PHYSIOLOGY  OF  TOOTH-MOVEMENT  AND  CHAEACTER  OF 
TISSUES  INVOLVED. 

In  changing  the  position  of  teeth  in  the  act  of  regulating, 
the  surrounding  tissues,  both  hard  and  soft,  are  largely 
involved. 

In  order,  therefore,  to  properly  comprehend  the  philosophy 
of  tooth  movement,  it  is  necessary  to  understand  the  struc- 
tural character  of  these  tissues  and  the  physiological  changes 
that  take  place  in  them  while  a  tooth  is  being  moved. 

The  Alveolar  Process. — This  process,  as  its  name  implies,  is 
not  a  separate  and  distinct  bone,  but  an  outgrowth  from 
another.  It  is  a  provisional  structure  designed  to  support 
the  teeth  in  position  and  afford  lodgment  for  the  nutrient 
vessels  leading  to  them.  It  is  formed  upon  the  body  of  the 
bones  of  the  jaw  as  the  teeth  are  developed,  growing  with 
them  until  they  are  fully  formed,  and  then  remaining  while 
'they  remain. 

When  the  teeth  are  lost,  there  being  no  longer  any  special 
use  for  it,  most  of  this  process  is  resorbed  and  carried  away. 
In  early  infancy  little  alveolar  structure  exists,  but  it  is 
formed  co-ordinately  with  the  growth  of  the  deciduous  teeth 
and  remains  during  the  period  of  their  retention.  Should 
they  be  lost  before  their  successors  are  ready  to  appear,  the 
process  will  be  entirely  removed  by  resorption,  and  a  new 
one  formed  for  the  accommodation  of  the  permanent  teeth. 
Where,  however,  the  deciduous  teeth  are  gradually  shed  to 
make  way  for  their  successors,  the  process  is  not  entirely 
resorbed,  the  basal  and  unabsorbed  portion  serving  as  a 
foundation  upon  which  the  new  structure  is  formed. 

The  alveolar  process,  being  built  or  formed  upon  the  body 
of  the  maxillary  bones,  conforms  to  them  in  outline  and 

50 


PHYSIOLOGY    OF    TOOTH-MOVEMENT.  51 

describes  the  same  curves.  In  depth  it  corresponds  to  the 
length  of  the  roots  of  the  teeth,  while  in  width  it  is  sufficient 
to  envelop  all  of  that  portion  of  the  tooth  beyond  the  termi- 
nation of  the  enamel.  It  gradually  increases  in  thickness 
as  it  approaches  the  body  of  the  bone  upon  which  it  rests. 

It  consists  of  an  outer  and  inner  plate  united  at  intervals 
by  sfepta,  thus  forming  alveoli  for  the  accommodation  of 
the  roots  of  the  teeth.  Its  main  portion  is  not  compact,  but 
open  and  spongy,  resembling  the  cancellate  structure  of  the 
diploe  of  the  bones  of  the  cranium  and  the  inner  portion  of 
other  bones.  Its  outer  or  cortical  layer  is  very  dense  and 
hard,  and  therefore  offers  greater  resistance  to  the  moving 
of  a  tooth  than  the  more  open  structure  beneath.  Its  cellu- 
lar structure,  while  giving  it  sufficient  firmness  to  assist  in 
supporting  the  teeth  in  their  positions,  affords  opportunity 
for  the  lodgment  and  passage  of  the  vessels  of  nutrition  and 
sensation  with  which  it  is  so  bountifully  supplied. 

Owing  to  its  peculiar  structure  and  great  vascularity,  the 
alveolar  process  is  readily  resorbed  under  the  stimulus  of 
pressure,  and  as  readily  reproduced  behind  the  moving  teeth. 

The  Teeth. — Of  the  teeth  themselves  little  need  be  said. 
The  student  is  familiar  with  their  number,  shape,  position 
and  structure.  Being  the  most  compact  organs  of  the 
human  body,  the  application  of  any  force  necessary  to  their 
movement  will  not  injuriously  affect  them  so  far  as  their 
hard  tissues  are  concerned. 

The  ease  or  difficulty  with  which  they  may  be  made  to 
change  their  positions  is  dependent  upon  the  number  and 
length  of  their  roots  and  the  thickness  of  the  process  sur- 
rounding them.  All  of  the  superior  teeth  can  be  more 
readily  moved  outward  than  inward,  on  account  of  the  thin- 
ness of  the  external  alveolar  plate.  The  ten  single-rooted 
teeth  in  the  lower  jaw  may  be  moved  outward  or  inward 
with  equal  ease,  while  the  lower  molars  are  more  readily 
moved  inward. 

All  of  the  teeth  can  be  more  easily  moved  in  the  line  of 


52  ORTHODONTIA. 

the  alveolar  arch  than  outward  or  inward,  because  the  septa 
are  composed  almost  entirely  of  cancellate  tissue  which 
yields  readily  to  pressure  and  is  quickly  resorbed. 

The  Pulp. — The  pulp  is  the  formative  organ  of  the  tooth, 
and  after  calcification  is  complete  it  remains  as  the  j^rinci- 
pal  source  of  nutrient  supply  for  the  dental  tissues,  espe- 
cially the  dentin. 

It  is  composed  of  fibrous  connective  tissue,  containing  a 
delicate  system  of  lymphatics  together  with  numerous  nerve 
filaments  which  enter  through  or  near  the  apical  foramen. 
Ramifications  of  minute  blood-vessels  are  noticeable  through- 
out its  whole  extent,  giving  color  to  the  organ  and  consti- 
tuting its  vascular  system. 

It  bears  an  important  relation  to  the  teeth  in  their  move- 
ment, since  it  may  be  readily  devitalized  through  impru- 
dence or  lack  of  care.  Before  calcification  of  the  teeth  has 
been  completed  the  apical  foramen  is  large  and  easily  accom- 
modates the  pulp  where  it  enters  the  tooth.  After  calcifica- 
tion is  complete  the  apical  foramen  is  small,  and  the  pulp  at 
this  point  is  in  consequence  greatly  reduced  in  size.  In  the 
ordinary  movement  of  teeth  there  is  generally  a  mechanical 
constriction  of  the  pulp  at  the  apex  due  to  the  tipi^ing  of 
the  tooth  in  moving.  If  the  movement  be  rapid  in  teeth 
fully  calcified  (after  the  sixteenth  or  eighteenth  year)  this 
constriction  may  be  so  great  as  to  cause  death  of  the  pulp 
through  strangulation.  Before  comj^lete  calcification  this  is 
not  likely  to  occur,  from  the  fact  that  when  the  foramen  is 
large  the  pulp  has  more  space  for  its  accommodation. 

In  the  movement  of  a  tooth  in  the  direction  of  i*s  length 
the  pulp  may  become  devitalized  through  excesssve  stretch- 
ing. This  has  occurred  at  times  in  drawing  down  into 
line  a  tooth  that  has  been  retarded  in  eruption.  In  all 
such  cases  care  must  be  exercised  and  the  movement  con- 
ducted slowly. 

The  Pericementum — The  pericementum  or  peridental 
membrane  is  that  tissue  which  envelops  the  root  of  the  tooth 


PHYSIOLOGY    OF    TOOTH-MOVEMENT.  53 

and  fills  the  space  intervening  between  it  and  the  alveolar  wall. 
It  is  a  tough,  strong  membrane,  composed  mainly  of  fibrous 
connective  tissue,  permeated  with  blood-vessels  and  nerve 
fibres,  and  containing  traces  of  a  lymj^hatic  system. 

It  is  strongly  adherent  to  the  alveolar  wall  of  the  socket 
on  the  one  hand,  and  to  the  cementum  of  the  tooth  on  the 
other,  its  adherence  being  due  to  the  extension  of  its  fibres 
into  both  the  bone  and  the  cementum.  These  fibres,  ac- 
cording to  Prof.  Black,*  "  are  wholly  of  the  white  or  inelastic 
connective  tissue  variety,"  and  the  apparent  elasticity  of  the 
membrane  is  due  to  the  passage  of  most  of  the  fibres  from 
cementum  to  wall  in  an  oblique  direction,  in  such  a  way  as 
to  "  swing  the  tooth  in  its  socket." 

This  membrane  is  the  formative  organ  of  the  cementum 
of  the  tooth,  and  also  assists  in  building  the  walls  of  the 
alveoli. 

The  cells  concerned  in  the  building  of  the  bony  walls  are 
known  as  osteoblasts,  and  those  forming  the  cementum  are 
designated  cementoblasts.  After  these  cells  have  performed 
their  normal  function,  they  become  encapsuled  and  form 
part  of  the  tissue  they  were  instrumental  in  building. 

When  re-formation  of  tissue  is  demanded,  as  in  the  thick- 
ening of  the  alveolar  wall,  or  in  increasing  the  normal 
amount  of  cementum  at  various  jDoints  under  certain  con- 
ditions, new  cells  are  originated  to  perform  the  work.  In 
the  moving  of  a  tooth  the  activity  of  these  new  cells  is  at 
once  manifested  in  the  formation  of  alveolar  tissue  to  fill 
the  space  caused  by  the  advancing  tooth. 

Beside  these  cells  of  construction  and  repair,  the  perice- 
mentum also  contains  cells  that  might  well  be  called  cells  of 
destruction.  They  are  the  osteoclasts  or  cementoclasts,  and 
their  function  is  to  break  down  or  resorb  the  cemental  or 
osseous  tissues  when  nature  calls  for  such  action. 

In  the  correction  of  irregularities  these  cells  perform 
valuable  service  in  removing  bony  tissue  in  front  of  the 
moving  tooth. 

*  Dental  Review,  vol.  I.,  p.  240.. 


54  ORTHODONTIA. 

The  pericementuni  is  thickest  in  childhood,  when  the 
sockets  or  alveoH  are  of  necessity  considerably  larger  than 
the  roots  of  the  teeth  which  they  contain.  With  advancing 
age  both  cementum  and  the  alveolar  walls  are  increased  in 
thickness  by  slow  but  continuous  growth  until  the  perice- 
mentum is  greatly  reduced  in  thickness,  and  in  consequence 
the  diameter  of  the  roots  more  nearly  approximates  that  of 
the  alveoli  or  sockets. 

The  pericementum  possesses  a  variety  of  function  not 
often  met  with  in  any  single  tissue  of  the  human  system. 

It  retains  the  tooth  in  its  socket  and  acts  as  a  cushion  to 
prevent  injury  to  the  adjoining  bony  structures  from  hard 
and  violent  concussions  to  which  the  teeth  are  sometimes 
subjected. 

It  affords  accommodation  for  numerous  blood-vessels 
which  supply  both  the  teeth  and  alveolar  tissue  with  nutri- 
ent material,  and  for  the  branches  of  nerves  which  consti- 
tute it  the  sensory  organ  of  the  tooth,  so  far  as  tactual 
impress  is  concerned. 

It  is  the  organ  of  construction  and  repair  of  both  cemen- 
tum and  bone,  and  is  also,  on  occasion,  the  organ  of  destruc- 
tion of  either  or  both  of  these  tissues. 

Physiology  of  Tooth  Movement. — In  the  ordinary  movement 
of  teeth  one  or  both  of  two  changes  take  place.  One  is  the 
resorption  of  alveolar  tissue  on  the  advancing  side  of  the 
tooth  and  its  reformation  on  the  opposite  side,  and  the  other 
a  bending  of  the  alveolar  plate  in  the  direction  of  the  applied 
force.  The  cancellate  tissue  is  easily  compressed  and  resorbed 
in  response  to  pressure,  but  the  cortical  layer  of  the  process 
offers  greater  resistance  and  is  less  readily  resorbed  on 
account  of  its  density. 

Where  the  cortical  layer  is  very  thin  at  the  alveolar 
border  as  on  the  labial  side  of  the  superior  anterior  teeth, 
and  on  both  the  labial  and  lingual  sides  of  the  inferior  ante- 
rior teeth,  it  is,  of  course,  more  easily  bent  than  in  the  region 
of  the  posterior  teeth  where  it  is  thicker.     For  this  reason 


PHYSIOLOGY    OF    TOOTH-MOVEMENT.  55 

the  superior  anterior  teeth  yield  most  readily  to  force  applied 
in  an  outward  direction,  while  the  anterior  teeth  of  the 
lower  jaw  yield  almost  equally  to  a  force  directed  either  out- 
wardly or  inwardly. 

When  force  is  exerted  upon  a  single  tooth  for  the  purpose 
of  moving  it,  the  first  effect  produced  is  the  compression  of 
the  pericementum  between  the  tooth  and  alveolar  wall  on 
the  advancing  side,  and  the  stretching  of  the  same  mem- 
brane on  the  opposite  side.  In  the  compression  of  the  mem- 
brane the  blood  supply  is  partly  cut  off,  and  the  nerves, 
by  their  irritation,  create  a  sensation  of  pain  which  is  soon 
obliterated  by  the  semi-paralysis  brought  about  by  continued 
pressure.  At  the  same  time  this  irritation  stimulates  and 
hastens  the  development  of  the  osteoclasts  which  at  once 
begin  the  work  of  breaking  down  and  resorbing  that  por- 
tion of  the  socket  pressed  upon. 

Bony  tissue  being  thus  removed,  accommodation  is  made 
for  the  advancement  of  the  tooth  which  at  once  takes  place. 
Under  continued  pressure  this  action  is  renewed  again  and 
again  until  the  tooth  has  reached  its  intended  position. 
While  this  is  taking  place  on  the  advancing  side,  quite  an 
opposite  condition  prevails  on  the  side  from  which>dvance- 
ment  has  taken  place.  There  the  fibrous  tissue  of  the  peri- 
cementum has  been  subjected  to  extreme  tension,  greater 
room  has  been  provided  for  the  accommodation  of  the 
nutrient  vessels,  and  osteoblasts  have  been  developed  for 
the  formation  of  bony  material  to  add  to  the  alveolar  wall 
and  thus  close  the  space  caused  by  the  movement  of  the 
tooth.  While  these  processes  of  resorption  and  reproduc- 
tion on  opposite  sides  of  the  tooth  have  been  going  on  coin- 
cidently,  their  results  have  been  very  unequal,  for  the 
resorption  of  bone  is  a  far  more  rapid  process  than  its 
formation. 

During  the  entire  time  of  moving,  and  for  a  long  time 
afterward,  the  tension  of  the  pericementum  on  the  free  side 
of  the  tooth  and  the  resiliency  of  the  bent  alveolar  jDlate  on 


56  ORTHODONTIA. 

the  advancing  side  are  kejDt  up  to  such  an  extent,  that  were 
the  pressure  or  means  of  retention  removed,  the  tooth  would 
quickly  be  forced  back  into  the  space  created  by  its 
movement. 

The  tendency  on  the  part  of  the  tooth  to  return  to  its 
original  position  is  only  finally  overcome  after  the  deposit 
of  osseous  matter  in  the  alveolar  socket  is  sufficiently  great 
and  dense  to  resist  the  opposing  forces. 

While  this  process  of  reparative  construction  has  been 
going  on  the  tissues  about  the  opposite  side  of  the  tooth 
have  been  adjusting  themselves  to  the  new  condition.  The 
pressure  upon  the  tooth  having  ceased  no  more  bone  is 
resorbed  or  bent ;  any  injury  inflicted  upon  the  pericemen- 
tum by  its  long  compression  is  repaired;  the  nerves  and 
blood-vessels  resume  their  normal  functions,  and  the  tooth 
in  its  new  position  becomes  a  far  more  useful  member  of  the 
dental  organism  than  it  had  been. 

When  a  number  of  adjacent  teeth  are  moved  outward  in 
the  anterior  expansion  of  the  arch,  the  principal  change  that 
occurs  in  the  alveolar  process  is  a  distinct  bending  or  yielding 
of  the  entire  outer  plate.  This  is  evidenced  by  the  rapidity 
with  which  the  movement  takes  place,  and  also  by  the  fact 
that  after  the  movement  is  completed  the  process  is  not  per- 
ceptibly thinner  on  the  advancing  side  or  thicker  on  the 
retreating  side  of  the  teeth  than  it  was  before  the  change 
took  place.  This  flexibility  of  the  process  is  due  to  its 
incomplete  calcification  at  the  period  of  life  when  opera- 
tions for  irregularity  are  usually  undertaken.  That  the  one 
alveolar  plate  should  yield  to  pressure  is  more  readily  com- 
prehended than  that  the  opposite  one  should  follow,  but  the 
uniting  septa  being  strong  and  elastic  draw  the  one  plate 
after  the  other  as  the  movement  takes  place. 

In  lateral  expansion  of  the  arch,  especially  in  the  molar 
region,  it  is  more  than  probable  that  the  space  is  gained  by 
the  opening  of  the  median  suture  which  can  readily  occur 
early  in  life.      Frequently  the  arch  is  widened  a  quarter  of 


PHYSIOLOGY    OF    TOOTH-MOVEMENT.  57 

an  inch  or  more  with  httle  effort,  and  this  could  scarcely  be 
accomplished  by  the  bending  or  resorption  of  the  thick 
outer  cortical  layer  of  the  process  in  this  region.  A  separ- 
ation at  the  rear  of  the  hard  palate  would  not  likely  be 
attended  by  separation  anteriorly  and,  therefore,  no  ill- 
results  would  follow. 

The  readiness  with  which  the  alveolar  process  yields  to 
pressure  early  in  life  is  an  important  aid  in  the  movement 
of  teeth  in  that  it  assists  in  hastening  and  simplifying  the 
operation,  but  advantage  should  not  be  taken  of  it  to  move 
teeth  too  rapily  for  fear  of  endangering  the  vitality  of  the 
pulp. 

In  extrusion  (forcing  a  tooth  partly  out  of  its  socket)  the 
fibres  of  the  pericementum  are  stretched,  but  the  alveolar 
walls  do  not  undergo  any  material  change,  while  the  space 
created  about  the  apex  of  the  root  and  somewhat  along  its 
sides,  is  soon  filled  with  new  alveolar  tissue.  The  stretching 
of  the  nerve  and  blood-vessels  that  enter  the  apical  foramen 
will  not  be  injured  if  the  movement  is  conducted  slowly. 

In  intrusion  (forcing  a  tooth  farther  into  its  socket)  resorp- 
tion of  alveolar  tissue  about  the  root  takes  place  as  in  other 
cases,  and  the  nutrient  vessels  are  more  or  less  compressed, 
but  they  adjust  themselves  to  the  condition  without  any 
ill-results. 


CHAPTER  VIII. 

DYNAMICS  OF  TOOTH  MOVEMENT. 

The  use  of  force  in  overcoming  resistance  and  causing 
malposed  teetli  to  assume  their  proper  positions  falls  within 
the  domain  of  that  branch  of  Physics  known  as  Dynamics. 

The  movement  of  teeth,  like  the  movement  of  other 
bodies,  is  regulated  and  controlled  by  certain  general  prin- 
ciples or  laws,  and  a  jDrojDcr  understanding  of  such  of  them 
as  are  of  importance  to  us  in  our  work  is  necessary  in  order 
that  the  required  operations  may  be  performed  intelligently 
and  in  a  scientific  manner.- 

To  construct  a  machine  which  by  its  action  will  accom- 
plish a  desired  result  may  be  easy,  but  to  devise  one  which 
will  give  us  the  best  result  without  a  waste  of  energy  or  an 
opposing  ill-result,  requires  familiarity  with  the  j)rinciples 
upon  which  it  is  to  operate  and  the  attendant  conditions 
which  may  limit  or  control  its  action. 

Three  mechanical  factors  enter  into  the  problem  of  tooth- 
movement. 

1.  Secure  anchorage. 

2.  Proper  application  of  force. 

3.  Character  of  resistance  to  be  overcome. 

Secure  Anchorage. — One  of  the  three  laws  governing  the 
application  of  force  as  enunciated  by  Newton  is : — Reaction 
is  always  equal  and  opposite  to  action.  A  scrcM^-jack,  for 
instance,  placed  under  a  house  to  elevate  it  exerts  as  much 
pressure  upon  the  ground  as  it  does  upon  the  building,  but 
as  the  resistance  of  the  ground  or  foundation  is  much 
greater  than  that  offered  by  the  house,  the  latter  rises  when 
the  screw  is  turned.  If  the  same  screw-jack  were  j)laced 
between  two  piles  of  equal  size  implanted  in  the  earth  to  the 

58 


DYNAMICS    OF    TOOTH    MOVEMENT.  59 

same  depth,  each  would  move  equally  when  the  screw  was 
turned  because  one  offered  no  more  resistance  than  the  other, 
action  and  reaction  being  always  equal.  In  like  manner  a 
screw  operating  between  two  similar  teeth,  as  molar  and 
molar  or  cuspid  and  cuspid  would  under  similar  conditions 
move  one  as  much  as  the  other.  When,  therefore,  it  is 
desired  to  move  but  one  of  the  teeth  between  which  the 
appliance  operates  the  one  used  as  an  anchorage  must 
be  much  more  firmly  implanted  that  the  one  to  be  moved. 
A  cuspid  would  not  serve  as  anchorage  in  moving  another 
cuspid  or  a  molar  for  a  molar,  but  either  a  molar  or  a  cus- 
pid might  offer  sufficient  resistance  for  the  moving  of  a  tooth 
of  less  fixedness  like  an  incisor  or  a  bicuspid.  Even  in  such 
case,  however,  a  single  anchor  tooth  as  firmly  implanted  as 
a  multi-rooted  molar  or  a  long-rooted  cuspid  would  be  likely 
to  be  moved  somewhat  out  of  position. 

To  secure  as  stable  anchorage  as  possible,  therefore,  we 
must  (1)  combine  the  resistance  of  several  teeth,  or  (2)  arrange 
to  counterbalance  the  force  exerted  upon  the  anchor  tooth  or 
teeth  in  one  direction  by  another  force  in  the  opposite  direc- 
tion, thus  making  these  forces  compensatory,  or  (3)  obtain 
an  anchorage  or  resistance  at  some  point  outside  of  the 
mouth,  as  on  the  top  or  back  of  the  head. 

In  any  proposed  movement  of  a  single  tooth  either  for- 
ward or  backward  in  the  line  of  the  arch,  it  has  long  been 
customary  to  select  as  an  anchor  tooth  one  having  others 
adjoining  it  on  the  side  of  the  desired  resistance.  However, 
even  when  several  teeth  thus  aid  in  offering  resistance  to 
the  force  applied,  all  of  them  will  often  yield  somewhat  to 
the  pressure  and  become  inclined  from  their  vertical  posi- 
tions, because  each  one  has  an  independent  movement  and 
frequently  the  main  anchor  tooth  will  be  slightly  elevated 
from  its  socket.  Many  cases  of  attempted  regulating  in  this 
way  have  resulted  in  failure,  because  after  the  teeth  used 
for  resistance  have  moved  and  become  loose  they  can  no 
longer  be  used  as  anchorage. 


60 


ORTHODONTIA. 


Fig.  11. 


Secure  Anchor  x-,e 


The  more  recent  method  of  joining  together  two  or  more 
teeth  by  means  of  united  metalhc  bands  does  away  with  the 
former  difficulty,  for  by  this  plan  no  tooth  can  move  inde- 
pendently of  the  others  nor  can  any  of  them  be  tipped 
from  their  vertical  j)Ositions.  Either  all  of  the  teeth 
included  in  the  anchorage  will  be  dragged  through  the 
alveolar  process  in  their  upright  positions,  or  by  their  united 

resistance  they  will  be  able  success- 
full}^  to  oppose  the  force  applied  to 
them.  The  latter  will  naturally  be 
the  result.  The  principle  involved 
is  well  shown  in  Fig.  11,  where  a 
molar  and  bicuspid,  joined  by  sol- 
dered bands,  offer  resistance  to  force 
applied  in  the  moving  of  a  cuspid 
tooth. 

Resistance  somewhat  analogous  to  this  is  obtained  by 
swaging  metal  caps  to  cover  the  occlusal  surfaces  of  the 
anchor  teeth,  soldering  them  together  and  cementing  them 
in  position.  Another  method  is  to  have  a  plate  covering 
the  palate  and  extending  laterally  so  as  to  include  and  cover 
several  anchor  teeth  on  each  side.  So,  also,  the  wire-crib 
appliance  is  used  to  obtain  the  combined  resistance  of  sev- 
eral teeth  in  the  moving  of  others.  All  of  these  methods 
are  valuable  and  oftentimes  one  is  more  available  than  any 
other,  but  none  of  them  furnish  the  same  firm  resistance  as 
is  secured  by  the  united  bands.  A  vulcanite  plate  covering 
the  roof  of  the  mouth  is  very  frequently  employed  as  a 
means  of  resistance  to  applied  power,  because  by  its  impinge- 
ment upon  many  teeth  the  resistance  is  distributed  over  a 
large  area  and  is  not  great  at  any  one  point.  It  is,  perhaps, 
the  least  valuable  of  all  devices  for  offering  resistance 
because  of  its  liability  to  displacement,  yet  it  may  be 
employed  advantageously  in  certain  cases. 

When  it  is  desired  to  move  a  tooth  either  outward  or 
inward   into   the   line  of  the   arch,  the   resistance   to   the 


DYNAMICS    OF    TOOTH    MOVEMENT. 


61 


Fig.  13. 


Anchorage  with  single  Band  and  Bar. 


Fig.  13. 


applied  power  will  usually  have  to  be  secured  at  a  point  on 
the  opposite  side  of  the  arch,  and  as  in  other  cases  be 
obtained  by  combining  the 
resistance  of  several  teeth. 
Fig.  12  shows  how  by  the 
use  of  a  single  band  with 
a  bar  attached  extending 
to  and  touching  the  two 
adjoining  teeth,  the  resist- 
ance of  three  teeth  is  of- 
fered to  the  moving  of  a 
cuspid  on  the  opj)Osite  side 
of  the  arch. 

Another  illustration 
of  the  same  principle, 
differently  applied,  will 
be  noticed  in  Fig.  13, 
where  by  the  use  of  a 
single  band  and  wire 
extension,  five  teeth  are 
made  to  offer  resistance 
in  the  moving  of  an 
opposite  cuspid. 

Fig.  11  shows  an  ingeni- 
ous combination  (devised 
by  Angle)  in  which  teeth  on 
both  sides  of  the  arch  are 
made  to  contribute  the  nec- 
essary resistance  for  the  mov- 
ing of  an  inlocked  lateral. 

The     second     method     of    ________^ 

securing     stationary     anchor-  Bllateral  Anchorage.     (Angle.) 

age,  that  of  opposing  a  force  in  one  direction  by  another  in 
the  opposite  direction,  is  an  extremely  valuable  one  where 
the  conditions  are  favorable  for  its  employment.  A  tooth 
thus  used  for  anchorage  will  remain  stationary  provided 


Re-entorced  Anchorage.    (  ingle.) 


Fig.  14. 


62  ORTHODONTIA. 

both  forces  are  equal.  An  illustration  of  this  principle  is 
given  in  Fig.  15,  where  it  is  desired  to  move  the  crown  of  a 
tooth  in  one  direction  and  the  root  in  an  oj^posite  one. 

Fig-  15.  The  third   plan 

of  obtaining  an- 
chorage, namely, 
that  of  using  the 
dome  of  the  head, 
is,  in  the  nature  of 
the  case,  limited 
in  its  applicability, 

Reciprocating  Forces.     (After  Case.)  n       ,         i  •, 

but  where  it  can 
be  utilized  it  is  an  ideal  method,  for  it  affords  an  amount  of 
resistance  far  beyond  any  possible  needs.  Practical  appli- 
cations of  the  principle  will  be  noticed  in  succeeding 
chapters. 

Proper  Application  of  Force. — When  power  is  to  be  applied 
for  the  movement  of  a  tooth,  attachment  for  the  purpose 
must  be  made  to  some  portion  of  the  crown,  as  that  is  the 
only  23art  available.  Resistance  to  such  movement  is  fur- 
nished by  the  alveolus,  and  especially,  when  the  movement 
is  in  a  labial  or  lingual  direction,  by  the  harder  cortical 
layer  covering  the  alveolar  plates.  If  all  of  the  bony  tissue 
comprising  the  socket  were  of  equal  density,  the  pivotal 
point  of  such  movement  would  be  very  near  the  apex  of  the 
root,  because  there  the  tissue  is  greatest  in  quantity.  As,  r 
however,  the  alveolar  tissue  about  the  root  and  especially 
towards  the  apex  is  open  and  spongy,  and  the  cervical  f)or- 
tion  of  the  root  is  almost  in  contact  with  the  dense  cortex,  it 
follows  that  the  j^ivotal  part  of  the  tooth  must  be  nearer 
this  surface. 

As,  therefore,  in  the  ordinary  movement  of  a  tooth  we 
have  a  resistance  to  be  overcome,  a  force  exerted  to  overcome 
such  resistance  and  a  fulcrum  or  point  of  relative  immo- 
bility, it  is  evident  that  the  tooth  in  its  movement  becomes 
a  lever. 


DYNAMICS    OF    TOOTH    MOVEMENT.  63 

A  lever  is  described  as  "  any  rigid  bar,  straight  or  bent, 
resting:  on  a  fixed  point  or  edge,  called  a  fulcrum."  The 
forces  acting  on  the  lever  are  the  weight  or  resistance  (W), 
the  power  (P),  and  the  reaction  of  the  fulcrum  (F).  Levers 
are  divided  into  three  classes.  In  the  first  class  the  fulcrum 
(F)  is  situated  between  the  power  Fig.  16. 

(P)  and  the  w^eight  (W),  as  in  a 
crow-bar  or  a  child's  see-saw.  In 
the  second  class  the  weight  (W)  is 
between  the  power  (P)  and  the 
fulcrum  (F),  as  in  a  wheelbarrow 
or  a  door.     In  the  third  class  the     '^  1 

power  (P)  is  between  the  fulcrum  Levers. 

(F)  and  the  weight  (W)  as  in  a  pair  of  tweezers  or  the 
human  forearm.  The  three  forms  of  the  lever  are  shown  in 
Fig.  16. 

In  the  ordinary  movement  of  a  tooth,  the  principle 
involved  is  that  of  a  lever  of  the  first  class,  the  distance  from 
P  to  F  representing  the  crown,  that  from  F  to  W  the  root, 
and  F  the  cortical  layer  of  the  alveolus.  If,  by  any  means, 
we  can  lessen  the  distance  between  F  and  W  or  increase 
that  from  F  to  P  we  will  gain  a  corresponding  advantage, 
for  on  the  principle  of  the  lever  (when  there  is  equilibrium) 
"  The  power  arm  is  to  the  weight  arm  as  the  weight  is  to 
the  power."      In  diagram  Fig.  p^^  ^^ 

17,  if  we  desire  to  raise  a  weight    _. p ^ 

of  20  lbs.  at  W  we  can  do  so  by  f 

1     •     „  1  J    i>  r-     Relation  between  Power  and  Weight. 

applying  a  downward  lorce  oi 

20  lbs.  at  P,  since  P  and  W  arc  equidistant  from  F.,  but  if 
we  apply  our  powder  at  P'  a  force  of  10  lbs.  will  accomplish 
the  same  result  because  the  distance  from  P'  to  F  is  twice  as 
great  as  the  distance  from  W  to  F.  Expressing  it  in  a  for- 
mula, we  have  P'F  :  WF  : :  W  :  P'  or  2  : 1  : :  20  :  10. 

Therefore,  in  any  attempt  to  move  the  crown  of  a  tooth, 
force  should  be  applied  as  near  the  occlusal  surface  as  pos- 
sible.    Converselv  when  we  desire  to  use  a  tooth  for  anchor- 


64 


ORTHODONTIA. 


Position  of  Band  for 
Anchorage  Attachment 


age,  our  attachment  should  be  made  as  near  the  cervical 
margin  as  possible  for  we  thus  shorten  the  distance  between 
the  power  and  the  fulcrum  and  correspondingly  lessen  the 
liability  of  moving  the  tooth. 

In  Fig.  18,  an  attachment  for  anchorage 
made  to  the  band  E  will  for  the  reason  just 
given,  accomplish  its  object  far  better  than 
if  made  to  a  band  in  the  position  of  D. 

When  we  desire  to  move  the  root  of  a 
tooth  without  moving  the  occlusal  por- 
tion of  the  crown,  we  must  do  so  on  the 
principle  of  a  lever  of  the  third  class.  The  fulcrum  F  must 
be  close  to  the  occlusal  surface  and  the  power  P  applied  as 
near  to  the  cervical  margin  as  possible  .in  order  that  the 
resistance  W  may  be  overcome  with  the  least  expenditure  of 
force.*  To  secure  a  fulcrum  at  the  occlusal  surface,  it  is 
necessary  to  have  a  band  attached  to  the  crown  at  this  point 
and  by  some  means  connect  this  band  with  the  anchorage. 
Prof.  C.  S.  Case  was  the  first  to  show  that  in  a  movement 
of  this  or  any  similar  kind  great  advantage  is  gained  by 
applying  the  power  at  some  j^oint  opposite  the  root  instead 
of  upon  the  crown.  His  method  of  doing  this  is  to  solder 
a  short  rigid  bar  to  the  band  surrounding  the  tooth  to  be 
Fig.  19.  moved  and  to  have  this  bar  extend  outside 
of  the  gum  in  the  direction  of  the  root  as  far 
as  the  lip  or  other  tissues  will  permit,  as 
shown  in  Fig.  19.  By  this  plan  the  force  is 
applied  nearer  to  the  end  of  the  root  and 
farther  from  the  cervical  margin  (fulcrum) 
thus  greatly  increasing  the  leverage.  How 
Bar  Extension  for  ^^rcc  applied  at  the  free  end  A  of  the  bar 
Increased  Leverage,  can  Operate  to  greater  advantage  in  moving 
the  root  than  if  applied  at  the  point  B  of  the  band  where 

*It  should  be  borne  in  mind  that  in  all  cases  W  represents  the  resistance 
to  be  overcome  and  that  vrith  a  tooth  the  root  or  roots  are  simply  one  arm  of 
a  lever.     The  actual  resistance  is  the  alveolar  tissue  surrounding  the  root. 


DYNAMICS    OF    TOOTH    MOVEMEXT. 


65 


the  bar  is  attached,  may  be  best  understood  by  reference  to 
the  diagram.     Fig.  20. 

Let  A  D  represent  a  lever  with  a  fulcrum  at  F.  To  this  is 
firmly  attached  another  rigid  rod,  B  C.  It  is  evident  that  any 
force  applied  to  the  arm  F  D  Fig.  20. 

in  one  direction  will   cause  /^ 

the  other  arm,  A  F,  to  move  a- 
in  the  opposite  direction  on  "        f 

the  principle  of  a  ieyer  of  the  first  class ;  but  since  the  two 
rods,  B  D  and  B  C,  are  rigidly  united,  they  must  act  in  uni- 
son so  that  a  force  exerted  at  any  point  along  f  C  will  cause 
the  arm  F  D  to  move  in  the  same  direction  and  A  F  to 
move  in  the  opposite  one.  Thus  we  see  that  the  motion  of 
F  A  is  the  same  whether  we  apply  the  power  along  f  C  or 
along  F  D,  and  conversely,  jjower  applied  in  one  direction 
at  any  point  of  the  arm  F  A  will  cause  both  f  C  and  F  D  to 
move  in  the  opposite  direction.  On  the  same  principle  any 
force  applied  at  C  in  the  direction  E  C  will  be  correspond- 
ingly felt  along  the  line  F  J).  Whether  the  bar  B  C  be 
straight,  curved  or  angular  will  make  no  difference  provided 
it  be  rigid.  Applying  these  principles 
to  the  moving  of  a  tooth  in  its  socket 
it  will  be  apparent  that  any  force 
ajDplied  above  the  alveolar  border  as  at 
C  (Fig.  21),  will  tend  to  move  the  root 
F  D  in  the  same  direction  whether  it  be 
labially  or  lingually,  for  it  is  equivalent 
to  applying  the  force  to  the  root  itself. 

Of  the  difierent  mechanical  powers 
several  are  employed  to  a  greater  or 
less  extent  in  the  regulation  of  teeth, 
although  the  greatest  efficiency  is  ob- 
tained from  the  screw. 

The  Lever. — The  principle  of  the  lever  is  not  often  embod- 
ied in  a  regulating  apj^liance,  both  on  account  of  its  inappli- 
cability and  because  other  forms  of  applying  force  serve  us 
to  better  advantage. 


W- — w 


Principle  of  Increased 
Leverage. 


66  ORTHODONTIA. 

The  Inclined  Plane,  —  This  is  used  only  in  very  rare 
instances,  although  where  applicable  its  efficiency  is  very 
great.  In  certain  simple  forms  of  malocclusion,  an  appli- 
ance embodying  this  princijDle  is  applied  to  teeth  in  one 
jaw  in  order  to  change  the  position  of  a  tooth  in  the  oppo- 
site one.  Occasionally,  also,  a  vulcanite  or  metal  plate  is 
made  with  a  portion  of  it  arranged  in  the  form  of  an 
inclined  plane  to  aid  in  changing  the  bite  or  occlusion  of 
the  teeth  in  the  opposite  jaw. 

The  Wedge.  —  Pieces  of  elastic  rubber  or  of  compressed 
wood  inserted  between  the  teeth  or  between  an  appliance 
and  a  tooth  are  usually  spoken  of  as  wedges,  but  they  are 
not  such  in  reality.  The  former  operates  by  virtue  of  its 
resiliency  and  the  latter  by  its  elasticity — that  is,  the  force 
is  derived  from  the  fibres  of  the  wood  resuming  the  form 
they  possessed  before  being  compressed.  Strictly  speaking, 
the  principle  of  the  wedge  has  never  been  employed  in  the 
movement  of  malposed  teeth. 

The  Screw. — The  screw  is  a  combination  of  the  inclined 
plane  and  lever.  Two  inclined  planes,  one  on  the  screw 
and  one  on  the  nut,  play  upon  each  other  and  are  oper- 
ated by  a  lever.  Its  slow  movement  together  with  its 
direct  delivery  of  force  and  positive  action  constitute  it  the 
best  form  of  mechanical  power  for  use  in  the  mouth  when 
conditions  favor  its  employment.  Usually  both  screw  and 
nut  are  of  metal,  but  sometimes  the  metallic  screw  is  made 
to  operate  in  a  threaded  hole  in  a  vulcanite  plate.  In  no 
other  form  of  instrument  is  the  application  of  force  so  com- 
pletely under  the  control  of  the  operator,  and  one  of  its 
great  advantages  is  that  it  can  be  operated  by  the  patient 
himself.  Its  wide  range  of  applicability  easily  places  it  at 
the  head  of  devices  for  the  moving  of  teeth. 

Elasticity. — Less  valuable  than  the  screw,  but  probably 
more  valuable  than  any  other  method  of  applying  power  is 
elasticity.  The  force  obtained  through  its  agency  is  less 
direct  and  positive  than  that  obtained  from  the  screw,  but 


DYNAMICS    OF    TOOTH    MOVEMENT.  67 

it  can  often  be  employed  to  advantage  when  the  latter  can- 
not and  hence  is  most  serviceable  in  applying  force  to  mal- 
posed  teeth.  It  is  usually  employed  in  the  form  of  a  bar, 
bow  or  spring  of  some  metal  or  its  alloys,  though  its  power 
is  also  utilized  through  the  agency  of  elastic  rubber  and  vul- 
canite, wood,  silk  and  linen  ligatures  and  other  substances. 

Character  of  Resistance  to  be  Overcome. — We  have  already 
spoken  of  the  general  structure  of  the  alveolar  process,  but 
in  order  to  obtain  a  clearer  understanding  of  the  character 
of  resistance  it  offers  to  the  movement  of  the  different  teeth, 
it  will  be  necessary  to  notice  certain  peculiarities  of  this 
structure  at  various  points  of  the  alveolar  arch. 

On  a  careful  examination  of  the  superior  maxilla,  we  will 
notice  that  in  the  incisor  region  the  outer  plate  of  the  alveo- 
lar process  is  exceedingly  thin  and  conforms  so  closely  to 
the  roots  of  the  teeth  as  to  distinctly  outline  their  form  and 
extent.  This  thinness  of  the  plate  is  due  to  the  fact  that  it 
is  composed  almost  entirely  of  the  cortex,  there  being  very 
little  cancellate  tissue  underlying  it.  Proceeding  backward 
we  find  this  outer  plate  gradually  increasing  in  thickness  to 
the  second  and  third  molars. 

With  the  inner  or  lingual  plate  it  is  different.  In  the 
incisor  region,  while  it  is  attenuated  at  the  alveolar  border, 
it  rapidly  increases  in  thickness  in  the  direction  of  the  roots 
on  account  of  the  cortical  layer  sloping  off  to  form  the  pal- 
ate. This  is  equally  true  of  that  portion  lying  next  to  the 
bicuspid  and  molar  teeth. 

Fig.  22  represents  a  section  of  the  supe- 
rior maxilla  adjoining  the  median  line.  B 
is  the  alveolus  or  socket  of  the  central 
incisor.  A  and  C  show  the  relative  thick- 
ness of  the  cortex  composing  the  external 
alveolar  plate,  with  very  little  cancellate  tis- 
sue underlying  it.  E  represents  the  thick  section  through  su- 
cortex  of  the  inner  plate,  not  only  near  the  P^rior  Aiveoiar  Pro- 

,,,--..  .  .  cess  near  Median  Line. 

alveolar  border,   but  m  its  contniuation  to 


68  ORTHODONTIA. 

form  the  palate,  while  D  indicates  the  large  amount  of  can- 
cellate  tissue  at  the  base  and  inner  portion  of  the  alveolus. 

It  will  thus  be  seen  that  owing  to  the  varying  character 
of  resistance  offered,  certain  movements  of  the  superior 
incisor  teeth  are  more  readily  accomplished  than  others. 

The  outward  movement  of  an  incisor  crown  is  effected 
with  comparative  ease,  because  the  outer  alveolar  plate  being 
thin  and  elastic,  bends  in  response  to  pressure,  while  the 
apical  end  of  the  root,  tending  to  move  in  an  opposite  direc- 
tion, presses  upon  the  cancellate  tissue  on  its  inner  surface, 
which  is  readily  broken  down  and  resorbed. 

The  inward  movement  of  the  same  crown  is  accomplished 
with  somewhat  greater  difficulty  because  there  is  very  little 
yielding  of  the  inner  alveolar  plate,  owing  to  its  mass  and 
solidity.  Thus,  while  the  crown  moves  inwardly  and  the 
root  outwardly,  the  cervical  portion  scarcely  changes  its 
position  at  all. 

In  nearly  all  cases  of  superior  protrusion  there  is  a  lack 
of  fulness  under  the  upper  portion  of  the  lip,  and  the 
improvement  of  facial  harmony  following  the  correction'  of 
the  deformit}^  is  due,  in  great  part,  to  the  outward  movement 
of  the  apical  ends  of  the  roots,  which  must  necessarily  accom- 
pany the  inward  movement  of  the  crowns.  This  is  equallj^ 
true,  though  to  a  lesser  extent,  in  similar  movements  of  the 
bicuspids.  In  the  superior  molar  region  both  alveolar  plates 
are  so  thick  that  it  is  doubtful  whether  they  bend  under 
pressure  to  any  appreciable  extent.  The  movement  of  these 
teeth  in  an  outward  direction  is  probably  accomplished  only 
through  the  slow  process  of  resorption,  or  by  a  separation 
of  the  two  halves  of  the  palate  at  the  median  suture.  In 
the  lower  jaw,  there  being  no  palate,  the  thickness  and 
structure  of  both  the  external  and  internal  plates  in  the 
incisor  region  are  very  similar,  which  accounts  for  the 
equal  facility  with  which  an  incisor  may  be  moved,  either 
in  a  labial  or  lingual  direction.  Fig.  23  illustrates  this 
condition,  the  lettering  of  the  parts  being  similar  to  that  in 
Fig.  22. 


DYNAMICS    OF    TOOTH    MOVEMENT. 


69 


Fig.  23. 


In  the  molar  (and  partly  in  the  bicuspid)  region  of  the 
inferior  alveolus,  the  teeth  are  even  more  immovably  fixed 
than  in  the  superior,  owing  to  the  greater  thickness  and 
prominence  of  both  alveolar  plates.  Great 
force  applied  to  move  the  lower  molars  out- 
wardly can  accomplish  its  object  only  by  slow 
resorption. 

A  marked  peculiarity  of  the  cortical  layer 
of  both  superior  and  inferior  maxillae,  is  that 
while  it  partly  encircles  the  teeth  at  their 
cervical  margins,  it  does  not  appear  to  cover 
the  free  edges  of  the  septa.  This  accounts  for 
the  fact  that  teeth  are  much  more  readily 
moved  either  forward  or  backward  in  the  line 
of  the  arch  than  in  a  direction  at  right  angles 
to  it.  The  septa  being  composed  entirely  of 
loose  cancellate  tissue,  its  resorption  readily  takes  place.  It 
also  explains  the  tendency  of  anchor  teeth  to  change  their 
positions  in  response  to  pressure  exerted  in  the'  line  of  the 
arch. 


Section  through 
Inferior  Maxilla 
near  Median  Line. 


PART    11. 

CHAPTER  I. 
MATERIALS   AND    METHODS. 

EXAMINATION  OF  THE  MOUTH. 

When  a  case  of  irregularity  presents  for  treatment,  the 
first  requirement  is  a  careful  examination  of  the  mouth 
and  teeth. 

In  conducting  this  examination  it  is  necessary  to  note 
the  position  of  the  teeth,  their  relation  to  one  another,  their 
occlusion  with  those  of  the  opposite  jaw,  the  relative  size 
and  shape  of  both  arches,  the  size,  character  and  condition 
of  the  teeth,  the  age  and  general  health  of  the  patient, 
the  harmony  or  inharmony  of  the  features  and  the  facial 
expression. 

A  careful  consideration  of  all  these  points  will  enable  us 
to  decide : — 

1st.  What  is  desirable. 

2nd.  Whether  it  can  be  done. 

3rd.  If  possible,  how  it  can  best  be  accomplished. 

After  this  preliminary  examination,  our  opinion  of  the 
case  should  be  given  the  patient  or  parent  accompanied  by 
a  plain  statement  of  the  difficulties  of  the  case,  if  such  exist, 
the  probable  time  that  will  be  required  for  correction,  and 
an  approximate  estimate  of  the  cost.  To  avoid  any  possible 
misapprehension  the  patient  should  also  be  informed  that 
the  aj^pliances  will  cause  some  annoyance  and  possibly 
some  pain,  and  that  patience,  endurance  and  perseverance 
will  be  necessary  on  his  or  her  part  to  enable  us  to  accom- 
plish a  satisfactory  result. 

70 


EXAMINATION.  71 

It  should  also  be  mutually  understood  that  the  parent  or 
patient  shall  assist  in  the  furtherance  of  the  work  by  seeing 
that  the  appliances  are  faithfully  worn,  that  all  the  instruc- 
tions are  carried  out,  and  that  the  patient  shall  punctually 
meet  all  appointments  that  may  be  made. 

Should  the  j^rognosis  of  the  case  prove  satisfactory  and 
all  of  the  above  conditions  be  agreed  to,  we  may  at  once 
proceed  with  the  treatment. 

Impression  and  Articulation. — The  first  step  will  be  to  take 
impressions  of  the  upper  and  lower  teeth  from  which  to 
secure  models  for  the  further  and  more  exact  study  of 
the  case. 

These  impressions  should  be  taken  with  some  material 
that  will  receive  a  sharp  imprint  and  not  materially  change 
its  shape  in  removal  from  the  mouth.  Either  Plaster  of 
Paris  or  Modelling  Composition  (Stent's  or  Godiva)  will  give 
satisfactory  results,  but  as  the  former  can  only  be  removed 
from  the  mouth  by  being  broken  into  many  pieces  the  latter 
is  generally  preferred.  In  selecting  the  impression  cups, 
those  known  as  flat-bottom  cups  should  be  chosen,  on 
account  of  the  better  accommodation  they  afford  for  the 
crowns  of  the  teeth.  The  cups  should  in  all  cases  be  large 
and  deep  enough  to  allow  for  a  sufficient  quantity  of  the 
material  along  the  outer  rim  to  enable  a  perfect  impression 
to  be  taken  of  the  labial  and  buccal  surfaces  of  the  teeth, 
and  as  much  of  the  gum  above  them  as  possible.  Figs.  24 
and  25  represent  cups  of  this  character  with  high  sides, 
devised  by  Dr.  Angle  for  the  taking  of  plaster  impressions, 
but  they  answer  quite  as  well  for  Modelling  Compound. 

A  proper  quantity  of  the  composition  having  been  softened 
by  dry  heat  or  in  hot  water,  it  is  placed  and  properly  shaped 
in  the  previously  warmed  cup  and  rapidly  introduced  into 
the  mouth. 

In  taking  an  impression  of  the  uj)per  jaw  the  mouth 
should  be  kept  well  open  so  that  the  teeth  may  not  come  in 
contact  with  the  material  before  the  proper  time  and  thus 


72 


ORTHODONTIA. 


mar  the  surface.  When  the  cup  with  its  contents  has  been 
placed  as  far  back  as  necessary,  and  immediately  beneath 
the  teeth,  it  should  be  brought  up  into  position  with  a 
straight  and  steady  movement.  Once  there,  it  should  be 
firmly  held  while  a  finger  is  introduced  to  force  forward 
into  position  the  portion  of  material  that  has  escaped  at 
the  rear  of  the  cup,  after  which  all  that  portion  along  the 
outer  rim  should  be  pressed  against  the  teeth  and  gums 
from  molar  to  molar. 

In  this  position  it  must  be  held  until  it  has  become  so 


Figs.  24  and  25. ^Angle's  Impression  Cups  for  Irregularities. 

hard  that  a  finger  nail  will  scarcely  indent  it,  when  it  should 
be  carefully  removed.  The  hardening  is  best  hastened  by  a 
stream  of  cold  water  from  a  syringe,  or  by  the  renewed 
application  to  the  cup  of  small  sponges  or  napkins  dipped 
in  ice  water  as  suggested  by  Prof.  Newkirk. 

In  taking  an  impression  of  the  lower  jaw  the  same  general 
method  is  followed,  and  after  the  cup  is  in  position  all  the 


IMPRESSIONS    AXD    ARTICULATION. 


73 


Fig.  26. 


surplus  material   around  both   the  outer  and   inner   rims 
should  be  pressed  into  place  with  the  finger. 

The  models  obtained  from  impressions  taken  in  this  man- 
ner will  be  sufficiently  accurate  to  give  us  a  good  represen- 
tation of  both  the  buccal  and  lingual  surfaces  of  the  teeth, 
so  necessary  to  a  proper  study  of  the  case. 

Impressions  taken  in  plaster  are  the  most  accurate. in 
detail,  but  the  compound  gives  us  all  the  accuracy  we  need 
in  models  for  regulating. 

During  the  same  sitting  at  which  the  impressions  are 
taken,  the  manner  in  which  the  teeth  occlude  should  be 
observed  and  recorded,  so  as  to  enable  us  to  place  the  models 
in  proper  relation  while  being  attached  to  the  articulator. 
This  will  dispense  with  the  necessity  for  taking  a  bite. 

An  i  n  e  X- 
pensive  and 
excellent  ar- 
ticulator, Fig. 
26,  for  the 
mounting  of 
models  of  ir- 
regularity, is 
made  from 
brass  wire. 
The  upper 
arms  and  coil 
are  one  con- 
tinuous piece, 
while  the 
lower  arms 
are  formed  by 
passing  an- 
other piece  of  the  wire  through  the  coil  and  bending  to  shape. 

The  articulator  is  so  slender  in  outline  that  after  the 
models  are  attached  to  it  the  occlusion  of  the  inner  cusps  of 
the  teeth  may  be  as  readily  examined  as  that  of  the  outer 
ones. 


The  Author's  Wire  Articulator. 


74  ORTHODONTIA. 

With  the  models  properly  mounted  on  the  articulator,  our 
second  and  more  deliberate  study  of  the  case  may  be  carried 
forward  at  our  leisure. 

At  the  first  or  personal  examination  of  the  case,  we  are 
supposed  to  have  decided  upon  the  advisability  of  an 
attempt  at  correction,  and  also  upon  the  general  jDlan  we 
purpose  pursuing.  By  the  study  of  the  articulated  models 
we  will  be  enabled  to  decide  ujDon  the  details  of  the  work 
and  the  kind  of  appliance  that  should  be  used.  Both 
studies  are  necessary,  for  with  the  patient  in  the  chair  we 
cannot  take  the  time  to  map  out  the  proposed  work  in 
detail,  while  an  examination  of  the  models  alone  will  leave 
us  without  a  knowledge  of  many  important  characteristics 
of  the  case  that  can  only  be  gained  from  a  personal  exami- 
nation. 

Articulated  models,  made  and  mounted  as  described,  are 
most  important  not  only  for  purposes  of  present  study,  but 
also  for  comparison  as  the  work  progresses.  Inasmuch  as 
they  represent  the  exact  condition  of  the  case  at  the  begin- 
ning, we  have  in  them  a  means  of  ascertaining  what  advance- 
ment has  been  made  at  any  stage  of  the  operation,  whether 
the  different  moA^ements  are  proceeding  satisfactorily,  and 
finally,  when  the  operation  is  completed,  of  observing  just 
how  much  change  has  been  effected.  An  ocular  comparison 
is  of  some  value,  but  one  made  with  calipers  and  rule  is  far 
more  exact  and  satisfactory. 

Study  of  Case  From  Articulated  Models. — The -study  of  the 
case  iRBij  be  either  a  simple  or  difficult  one,  according  to  the 
conditions  and  requirements  involved.  Thus,  the  move- 
ment of  a  single  tooth  will  only  involve  the  consideration  of 
providing  accommodation  for  it  in  the  arch  and  the  manner 
of  applying  force  to  bring  it  into  position,  whereas  when  a 
number  of  teeth  in  different  locations  are  to  be  moved,  each 
perhaps  requiring  a  different  form  of  movement,  we  will 
have  to  decide  whether  we  can  and  should  produce  all  of 
these  movements  with  one  ajDjjliance  at  one  time,  or  whether 


STUDY    OF    CASE.  ,  75 

it  would  be  best  to  produce  each  movement  separately  and 
possibly  with  different  appliances.  If  the  latter,  we  will  have 
to  determine  which  should  be  accomplished  first,  which 
next,  and  so  on. 

For  instance,  where  the  entire  upper  arch  is  to  be  expanded 
to  make  room  for  outstanding  cusjoids,  we  will  have  three 
different  operations  to  perform;  the  side  teeth  must  be 
moved  laterally,  the  anterior  ones  forward  and  the  cuspids 
inward  into  line.  To  produce  all  of  these  movements  at  the 
same  time  with  one  appliance  would  be  impossible  from  the 
nature  of  the  case,  therefore  they  will  have  to  be  performed 
separately,  and  usually  in  the  order  in  which  they  have 
been  named.  In  attempting  to  produce  many  movements 
with  one  appliance  we  often  defeat  our  object,  although 
occasionally,  where  the  movements  to  be  produced  are  of 
opposite  character,  we  may  advantageously  play  one  against 
the  other. 

Where  they  are  of  the  same  character,  or  nearly  so,  too 
much  should  not  be  attempted  at  one  time,  for  the  loosen- 
ing of  many  teeth  will  be  liable  to  make  our  anchorage 
unstable,  in  which  case  we  would  have  to  suspend  all  opera- 
tions until  some  of  the  teeth  again  became  firm. 

Having  decided  upon  the  order  in  which  the  movements 
should  take  place,  we  have  two  other  important  points  to 
determine. 

Amount  of  Power  Required. — This  will  be  determined 
largely  by  the  age  of  the  patient  and  the  character  of  the 
teeth  and  process.  As  previously  stated,  earl}'-  in  life,  before 
the  process  has  become  fully  calcified,  the  teeth  can  be 
moved  more  rapidly  than  at  a  later  period,  and  less  power 
will  be  required  to  accomplish  it ;  so  also,  in  patients  of  the 
same  age,  the  teeth  of  one  will  be  more  readily  moved  than 
those  of  the  other.  This  is  due  both  to  the  relative  length 
of  the  roots  and  the  resistance  of  the  alveolar  walls  with 
their  dense  cortical  covering,  and  as  we  cannot  judge  of 
either  with  any  degree  of  exactness,  we  have  to  form  our 
opinion  in  the  matter  from  the  general  conditions. 


76  ORTHODONTIA. 

Observation  has  shown  that  teeth  with  large  crowns,  situ- 
ated in  large  and  firm-looking  jaws,  usually  have  long  roots  ; 
whereas,  smaller  teeth,  associated  with  thin  and  more  deli- 
cate processes,  have  shorter  roots. 

Therefore,  considering  the  age  of  the  patient  and  the 
appearance  of  the  teeth  and  processes,  we  can  at  least  decide 
whether  the  amount  of  force  to  be  applied  should  be  great 
or  little. 

Manner  of  Applying  Power. — Among  the  many  appliances 
or  substances  for  yielding  power  in  the  moving  of  teeth,  the 
practitioner  has  a  range  of  choice  from  the  screw  with  its 
directness  and  power,  to  the  silk  ligature  with  its  gentle 
traction. 

Between  these  two  extremes  we  have  materials  that  will 
yield  us  force  in  any  desired  degree.  Selecting  the  one 
which  seems  best  suited  to  the  case,  we  must  next  decide 
upon  the  most  advantageous  manner  of  using  or  applying  it. 

There  are  two  general  methods  of  securing  the  power- 
producing  appliances  in  the  mouth.  One  is  the  use  of  a 
plate  of  some  kind  to  which  attachments  can  be  made,  and 
the  other  is  the  plan  of  attaching  the  appliances  to  the 
natural  teeth  in  such  a  way  as  to  dispense  with  the  wearing 
of  a  plate. 

In  certain  methods  of  regulating,  such  as  Angle's,  Jack- 
son's and  Patrick's,  no  plate  is  used ;  while  in  others,  such 
as  Coffin's,  a  plate  is  invariably  used  for  attachment  and 
security. "  Farrar  advocates  the  use  of  a  plate  only  in  excep- 
tional cases.  Each  manner  has  its  advantages  and  disad- 
vantages.    In  the  use  of  a  plate,  we  have  as  advantages : — 

Its  Convenience  and  Adaptability. — Covering  a  large  sur- 
face, it  affords  opportunity  for  the  attachment  of  the  imme- 
diate power-yielding  appliance  in  any  position  and  at  any 
angle,  and  permits  the  same  to  be  altered  or  changed  with 
very  little  trouble.  It  also  protects  the  soft  tissues  from  any 
possible  injury  which  might  result  from  the  slipping  or 
impingement  of  other  appliances  upon  them.      Indeed,  in 


MANNER    OF    APPLYING-    POWER.  77 

many  cases,  a  plain  rubber  or  metal  plate  covering  the  roof 
of  the  mouth  and  not  having  any  appliances  attached  to  it, 
is  used  simply  for  the  protection  of  the  gums  during  the 
operation  of  regulating. 

Its  Distribution  of  the  Power  of  Resistance. — Touching  all 
or  nearly  all  of  the  teeth  not  being  operated  upon,  it  com- 
pels each  one  to  bear  its  part  in  offering  resistance  to  the 
power  applied  for  the  movement  of  certain  teeth,  and  in  this 
way  brings  more  teeth  into  use  as  points  of  resistance  than 
could  possibly  be  done  by  any  other  method. 

Its  simplicity  of  construction  and  the  facility  it  affords  for 
adjustment  and  alteration. 

The  disadvantages  pertaining  to  the  emplojanent  of  a 
plate  as  an  aid  in  regulating,  are  : — 

Its  Uncleanliness. — Inasmuch  as  a  plate  comes  in  contact 
with  so  much  tooth  surface  at  the  necks  and  elsewhere,  it 
offers  special  opportunity  for  the  accumulation  of  debris.  In 
plates  that  are  removable  by  the  patient,  this  may  be  largely 
avoided  by  frequent  cleansing,  but  observation  has  shown 
that  the  majority  of  patients  are  either  so  careless  or  indif- 
ferent in  regard  to  the  matter,  that  a  clean  regulating  plate 
is  seldom  seen.  In  plates  so  constructed  or  arranged  that 
only  the  dentist  can  remove  them,  the  uncleanliness  of  the 
plate  and  consequent  danger  of  injury  to  the  teeth  is  greatly 
increased. 

The  Frequent  Appointments  Necessary. — In  the  class  of  plates 
last  alluded  to,  it  is  absolutely  important  that  they  be  removed 
and  cleansed  at  least  once  in  every  forty-eight  hours.  This 
requires  such  frequent  visits  on  the  part  of  the  patient  and 
the  expenditure  of  so  much  valuable  time  on  the  part  of 
the  operator,  as  to  constitute  a  serious  objection  to  the  use 
of  plates  where  they  can  at  all  be  dispensed  with. 

When  plates  are  not  used,  appliances  are  usually  attached 
directly  to  certain  teeth  which  serve  as  anchorages.  Such 
attachment  is  generally  secured  by  means  of  bands  or  collars 
encircling  the  teeth  and  cemented  to  them;  or,  in  other 


78  ORTHODONTIA. 

cases,  by  having  the  bands  simply  passed  around  tlie  teeth 
of  attachment  and  drawn  tight  by  means  of  screws  or  clamps. 

When  bands  are  placed  around  teeth  and  secured  by  some 
mechanical  device,  they  never  can  fit  the  teeth  so  accurately 
as  to  avoid  spaces  for  the  accumulation  of  food  and  saliva. 
The  fermentation  of  the  particles  of  food,  and  the  acidity  of 
the  saliva  in  a  state  of  rest,  will  soon  injuriously  affect  even 
good  tooth  structure. 

This  can  only  be  prevented  by  the  employment  of  some 
material  that  will  perfectly  fill  the  space  between  the  band 
and  the  tooth,  therefore  all  bands  passing  around  and  encir- 
cling the  teeth,  in  order  to  be  harmless,  should  be  cemented 
in  place  with  phosphate  of  zinc. 

The  advantages  of  appliances  attached  to  the  teeth  in  this 
way  are : — 

1st.  The  leaving  of  the  roof  of  the  mouth  uncovered,  thus 
affording  more  room  for  the  movements  of  the  tongue. 

2nd.  Their  greater  cleanliness,  because  they  touch  the 
teeth  at  few  points,  and  thus  furnish  good  opportunity  for 
thorough  cleansing  with  the  brush. 

3rd.  Not  needing  to  be  removed,  fewer  visits  to  the  dentist 
are  necessary,  thus  effecting  a  great  saving  in  time  and  labor. 


CHAPTER  II. 
APPLIANCES. 

MATERIALS  AND  THEIR  USES. 

During  the  study  of  the  case,  after  we  have  decided  upon 
the  amount  and  kind  of  power  we  wish  to  apply  in  order  to 
produce  the  desired  movements,  it  will  be  necessary  to  con- 
sider the  different  materials  at  our  "disposal  in  order  that  we 
may  select  from  them  the  ones  best  suited  to  our  purpose 
for  the  case  in  hand. 

Platinum  and  Its  Alloys. — Platinum,  on  account  of  its 
tastelessness,  its  non-oxidability  and  its  harmonious  color, 
should  constitute  it  one  of  the  best  metals  for  use  in  the 
mouth.  Its  extreme  pliability  and  softness,  however,  greatly 
limit  its  usefulness,  so  that  it  can  be  used  only  where  these 
latter  qualities  do  not  interfere  with  its  employment. 

It  is  chiefly  used  in  the  construction  of  bands  that  are  to 
be  cemented  to  the  teeth  to  serve  as  anchorages  for  appli- 
ances or  to  form  parts  of  retaining  fixtures. 

In  combination  with  other  metals,  in  the  form  of  alloys, 
its  greatest  usefulness  is  developed. 

Iridio- Platinum. — This  alloy,  combining  the  color  and 
purity  of  platinum  with  the  hardness  and  stiffness  of 
iridium,  is  useful  for  bands,  bars  and  wires  in  connection 
with  regulating  appliances  where  platinum  alone  would 
not  be  available  on  account  of  its  softness. 

It  can  be  hard-soldered  without  losing  its  elasticity. 

Platinous  Gold. — Gold  in  a  pure  state,  or  alloyed  with 
silver  or  copper,  does  not  possess  the  stiffness  necessary  for 
its  use  in  the  form  of  bars,  springs  or  accessories,  where 
great  resistance  or  elasticity  is  requisite,  but  when  alloyed 
with  about  five  per  cent,  of  platinum  it  attains  a  degree  of 

79 


80  ORTHODONTIA. 

elasticity  second  only  to  steel.  In  this  form  it  is  one  of  our 
most  useful  materials,  for  even  the  heat  of  soldering  does 
not  rob  it  of  its  elastic  quality. 

This  alloy  of  gold  can  be  purchased  in  the  dental  depots 
in  plate  of  any  thickness  and  in  wire  of  any  form  or  size. 
When  used  for  the  construction  of  screws  or  supports,  its 
stiffness  is  the  projDerty  taken  advantage  of,  while  in  the  form 
of  levers  or  bows  its  elasticity  constitutes  its  chief  excellence. 

Platinous  Silver. — This  alloy,  though  long  and  favorably 
known  in  England,  has  never  been  extensively  used  in 
America.  It  is  prepared  for  the  market  in  the  form  of  plate 
and  wire  of  every  gauge.  In  the  form  of  plate  it  is  largely 
used  abroad  as  a  base  for  artificial  dentures,  especially  small 
partial  pieces,  while  the  wire  is  used  as  a  support  for  the 
Ash  tube-teeth  and  other  purposes. 

The  alloy  is  composed  of  one  part  of  platinum  to  two  of 
silver.  Its  stiffness  and  elasticity  is  but  little  inferior  to 
jDlatinous  gold,  while  its  cost  is  about  one-half  that  of  gold. 
It  can  be  rolled,  bent  or  fashioned  to  any  form  and  may  be 
soldered  with  the  highest  grades  of  gold  solder. 

In  the  form  of  wire  the  author  has  found  it  very  useful  in 
the  construction  of  bows  for  the  attachment  of  rubber  bands 
or  ligatures  to  draw  teeth  in  any  direction,  and  for  parts  of 
retaining   appliances  where  inconspicuousness  is  desirable. 

Its  non-oxidability  is  also  a  feature  of  considerable  value. 

Platinoid. — A  new  alloy,  under  this  name,  has  recently 
been  brought  out  as  a  substitute  for  other  platinous  alloys. 
In  its  i^roperties  it  greatly  resembles  iridio-platinum.  It 
probably  contains  no  j)latinum,  but  it  is  inexpensive,  almost 
non-oxidable  and  very  elastic.  It  comes  in  all  thicknesses 
of  plate  and  all  forms  of  wire. 

German  Silver. — This  improperly  named  alloy,  composed 
of  copper,  zinc  and  nickel,  is  frequently  employed  in  the 
construction  of  regulating  appliances,  on  account  of  its  stiff- 
ness and  inexpensiveness.  While  it  may  be  regarded  as  a 
base  compound,  its  baseness  is  of  so  high  a  grade  that  it 


MATERIALS.  81 

may  be  used  without  fear  of  harm  to  the  soft  tissues  or  the 
general  system.  Prof's.  Angle,  Matteson  and  Jackson  use  it 
very  largely  in  the  construction  of  their  appliances,  and  the 
author  has  made  frequent  use  of  it  without  ever  noticing 
any  deleterious  efltects.  Hard-drawn  wire  of  this  alloy 
serves  admirably  for  bows  or  bars,  and  soft-soldering  does 
not  destroy  its  temper.  Its  valuable  qualities  are  many, 
and  the  ease  with  which  it  may  be  electro-gilded  furnishes 
us  with  a  means  of  improving  its  appearance.  . 

Gold. — Gold,  in  its  non-elastic  condition,  has  been  and 
probably  always  will  be  one  of  the  most  useful  of  the  metals 
for  the  construction  of  parts  of  regulating  appliances.  Its 
softness,  adaptability  and  strength  are  all  qualities  of  the 
greatest  value  and  render  it  serviceable  in  numberless  ways. 
To  j)reserve  its  purity,  and  as  far  as  possible  to  prevent  oxi- 
dation, it  should  never  be  used  of  a  carat  less  than  20  or  22. 

Steel. — This  metal  has  the  same  desirable  qualities  of  firm- 
ness and  elasticity  that  are  found  in  platinous  gold,  and 
possesses  them  in  a  higher  degree,  so  that  it  is  used  in  pref- 
erence to  the  former  metal  where  greater  power  is  needed. 

There  are  two  disadvantages,  however,  connected  with  its 
use : — one  is,  that  it  cannot  be  highly  heated  (as  in  solder- 
ing) without  destroying  its  temper;  and  the  other,  that  it 
oxidizes  so  readily  when  in  contact  with  the  fluids  of  the 
mouth.  This  latter  objection  is  largely  overcome  by  electro- 
plating it  with  gold,  a  full  description  of  which  method  will 
be  found  in  the  latter  part  of  this  volume.  It  is  used  prin- 
cipally in  the  construction  of  jack-,  and  other  screws  and  as 
wire  in  the  form  of  bows,  levers  and  springs. 

Vulcanite. — Soon  after  the  introduction  of  vulcanite  as  a 
base  for  artificial  teeth,  its  qualities  of  adaptability,  strength 
and  elasticity  were  recognized  and  utilized  in  the  construc- 
tion of  appliances  for  regulating.  By  its  use  we  secure 
advantages  that  could  not  so  readily  be  gained  from  other 
substances. 


82  ORTHODONTIA. 

Used  either  to  i^roduce  pressure  by  its  own  elasticity,  or  as 
a  medium  for  the  attachment  of  other  power-producing 
appHances,  it  has  been  one  of  the  most  commonly  employed 
materials  for  the  construction  of  regulating  appliances. 

Compressed  Wood. — The  use  of  this  substance  is  very  old. 
Before" thelntroduction  of  either  soft  or  vulcanized  rubber, 
the  expansibility  of  compressed  wood  under  moisture  was 
employed  in  lieu  of  elasticity. 

It  was  used  chiefly  in  the  form  of  small  sections  placed 
between  a  silver  or  gold  j^late  and  the  teeth  to  be  moved,  a 
suitable"  slot  or  socket  having  been  formed  in  the  plate  for  its 
retention. 

In  this  way  it  is  no  longer  used,  other  materials  possess- 
ing superior  qualities  having  superceded  it. 

The  author  occasionally  finds  great  advantage  from  its 
use  in  the  separation  of  teeth  for  the  accommodation  of 
some  malposed  tooth,  where  the  existing  space,  though  not 
sufficient,  is  still  too  great  to  admit  of  the  use  of  elastic  rubber. 

In  such  cases  it  is  his  custom  to  cut  a  cross-section  from 
some  compressible  wood,  such  as  cotton-wood,  a  little  larger 
than  the  space  it  is  to  occupy.  This  is  compressed  in  the 
direction  of  the  length  of  the  fibre  by  means  of  a  hammer, 
after  which  it  is  notched  at  each  end  to  fit  the  convex  sur- 
faces of  the  teeth  to  be  moved.  Upon  being  placed  in  posi- 
tion its  expansion  by  the  absorption  of  the  fluids  of  the  mouth 
quickly  causes  movement  of  the  teeth.  In  the  course  of  its 
expansion  it  adapts  itself  accurately  to  the  tooth  surfaces 
and  thus  does  not  become  dislodged  or  slijD  from  its  position. 

Sea-Tangle. — This  is  one  of  the  newer  substances  intro- 
duced into  the  list  of  materials  that  are  of  service  in  regu- 
lating. The  idea  of  its  use  was  borrowed  from  the  medical 
fraternity,  who  first  employed  it  for  dilatation  of  the  cervix 
uteri.  It  is  a  variety  of  sea-weed  botanically  known  as 
laminaria,  that  has  been  robbed  of  its  moisture  and  com- 
pressed until  its  density  is  about  equal  to  horn.  For  medi- 
cal use  it  comes  in  the  form  of  a  cylindrical  tent  about  one- 
fourth  of  an  inch  in  thickness  and  two  inches  in  length. 


MATERIALS.  83 

This  is  the  only  form  in  whicli  it  has  been  placed  upon 
the  market.  In  the  presence  of  moisture  it  rapidly  expands 
from  two  to  three  diameters.  As  it  expands  only  in  the 
direction  of  its  width,  sections  from  it  must  be  so  cut  and 
shaped  as  to  take  advantage  of  this  lateral  enlargement. 

In  regulating  it  may  be  employed  in  place  of  compressed 
wood,  and  like  it  is  used  to  produce  pressure  between  the 
unyielding  plate  and  the  tooth  to  be  moved.  A  place  for  it 
is  readily  provided  by  cutting  a  hole  or  socket  in  the  rubber 
plate  at  the  desired  point. 

Its  advantage  over  rubber  or  wood  lies  in  its  greater 
expansive  properties  and  the  ease  with  which  it  can  be 
secured  in  place.  A  piece  of  suitable  size  may  be  placed  in 
position  and  the  plate  properly  secured  in  the  mouth  before 
expansion  begins. 

Elastic  Rubber. — The  resilience  of  elastic  rubber  was  early 
recognized  as  a  valuable  property  that  might  be  used  to 
advantage  in  producing  traction  upon  teeth  to  be  moved. 
It  was  first  used  in  the  form  of  strips  attached  at  either  end 
by  ligature,  but  since  the  introduction  of  rubber  tubing, 
rings  or  bands  cut  from  the  same  have  been  employed 
instead.  Their  first  emjiloyment  has  been  credited  to 
Dr.  E.  G.  Tucker,  of  Boston,  about  the  year  1846. 

These  sections,  cut  from  the  smaller  sizes  of  French  rubber 

tubing,  are  now  in  almost  universal  use 

Fig  27 
in    coiniection  with   other  appliances  for 

regulating,  and  their  value  has  been 
greatly  enhanced  since  the  Magill  band 
has  furnished  a  better  means  for  their 
attachment. 

Their  power,  though  great,  is  limited,  sizes  of  Rubber  Tubing 
for  they  cannot  exert  so  great  a  force  as     ^lost  generally  used, 
the  metals,  but  their  wide  range  of  applicability  and   the 
persistence   of  their   power  places   them  among   the  most 
valuable  adjuncts  of  regulating  devices. 


84  ORTHODONTIA. 

In  use,  their  tendency  to  slip  off  the  tooth  or  up  under 
the  gum  (whic]:i  constitutes  tlie  chief  objection  to  their 
employment)  must  be  guarded  against  by  so  securing  them 
that  change  of  position  will  be  impossible.  They  should 
never  be  permitted  to  rest  upon  or  touch  the  soft  tissues  at 
any  point. 

Silk  Ligatures. — The  contraction  of  silk,  linen  or  cotton 
thread  in  contact  with  moisture,  enables  us  to  make  use  of 
it  where  the  gentlest  tractile  jDower  is  desired.  Most  fre- 
quently it  is  emj^loyed  simply  as  a  ligature  in  attaching 
some  appliance  to  the  teeth,  but  it  has  often  been  used  to 
advantage  in  cases  where  teeth  were  to  be  moved  slowly 
and  a  very  short  distance.  Prof  Peirce  employs  it  in  this 
way  for  the  moving  of  certain  single-rooted  teeth.  Its  gentle 
power,  together  with  its  safety  and  simplicity,  will  often  prove 
the  very  qualities  we  desire  in  certain  simple  operations. 

Linen  Floss. — This  material  is  almost  as  serviceable  as 
silk-floss  and  much  less  expensive.  Besides  being  very 
strong  it  contracts  greatl}^  when  moistened,  and  is  not  liable 
to  change  its  position,  especially  if  well  waxed. 

China- Grass  Line. — This  material  has  been  extensively 
used  in  Xew  England  for  ligatures  in  regulating,  being  pre- 
ferred for  that  jDurpose  to  silk,  cotton  or  linen. 

It  is  the  Boehmeria  nivea  of  botanists,  and  more  commonly 
known  as  Ramie  or  Rhea  fibre,  and  is  the  material  from 
which  China-grass  cloths  are  manufactured.  It  is  stiff 
enough  to  be  threaded  with  a  pair  of  tweezers  between  the 
teeth  at  their  necks,  thus  avoiding  the  pain  of  forcing  a 
ligature  between  them  when  tender. 

It  is  non-elastic,  but  shrinks  greatly  without  softening 
when  moist,  thus  exerting  considerable  traction  without 
producing  pain.     It  comes  in  the  form  of  fish-lines. 


DESIRABLE    QUALITIES.  85 

QUALITIES  AN  APPLIANCE  SHOULD  POSSESS. 

In  selecting  a  form  of  appliance  from  among  the  many 
that  have  been  devised  by  writers  and  workers  in  this  field 
of  practice,  or  in  devising  one  to  suit  the  demands  of  the 
case  under  consideration,  it  will  be  well  to  consider  and  bear, 
in  mind  the  qualities  any  appliance  should  possess  in  order 
to  render  it  most  effective. 

The  following  are  among  the  most  important  of  such 
qualities  : — 

Efficiency. — The  first  requirement  of  any  device  is,  that  it 
shall  be  able  to  do  the  work  expected  of  it.  All  appliances 
are,  of  course,  devised  with  this  end  in  view,  but  the  attain- 
ment of  it  is  often  not  as  simple  a  matter  as  might  at  first 
appear.  Almost  every  case  has  associated  with  it  so  many 
features  and  peculiarities  claiming  consideration,  that  even 
with  the  greatest  care  and  thought  we  often  fail  to  apprehend 
or  grasp  each  individual  complication.  Some,  indeed,  are 
so  little  apjDarent  that  they  can  scarcely  be  recognized  in 
advance. 

For  this  reason  even  the  most  experienced  practitioners 
will  at  times  devise  an  appliance  which,  though  seemingly 
meeting  all  the  requirements,  will,  when  brought  to  a  prac- 
tical test,  fail  to  accomplish  the  end  desired.  It  will  then 
have  to  be  altered  or  perhaps  discarded  in  favor  of  some 
other  fixture  more  perfectly  adapted  to  the  requirements  of 
the  case. 

An  appliance  that  will  not  yield  the  results  we  desire,  or 
which  yields  them  in  an  imperfect  manner,  should  in  all 
cases  be  superseded  by  another. 

Simpliciiy. — A  complicated  device  is  in  nearly  all  cases  less 
efficient  than  a  simple  one.  Simplicity  is  a  cardinal  virtue 
in  all  matters  of  construction,  and  through  lack  of  it  about 
seventy-five  per  cent,  of  the  patents  granted  in  this  country 
prove  unprofitable. 

Far  greater  mechanical  ingenuity  is  displayed  in  an  effec- 
tive simple  device  than  in  a  complicated  one. 


86  ORTHODONTIA. 

Rapidity  of  Action. — In  order  to  lessen  the  discomfort  of  the 
patient  and  to  conserve  the  time  of  both  patient  and  oj^era- 
tor,  a  regulating  appliance  should  be  as  rapid  in  its  action 
as  is  consistent  with  physiological  conditions.  Too  rapid 
action  may  cause  suffering  to  the  patient  and  possibly  bring 
about  deleterious  results,  while  too  slow  action  will  prolong 
the  treatment  unnecessarily  and  possibly  cause  the  patient 
to  become  disheartened  and  abandon  the  treatment. 

Between  these  two  extremes  there  is  a  mean  in  which  the 
best  results  are  accomplished. 

All  regulating  appliances  are  at  best  a  source  of  some  dis- 
comfort to  the  patient.  A  foreign  body  in  the  mouth,  occu- 
pying a  certain  amount  of  space  and  thereby  interfering 
more  or  less  with  natural  functions,  cannot  fail  to  be  objec- 
tionable. In  order,  therefore,  to  lessen  his  discomfort  as 
much  as  possible,  we  should  try  to  devise  appliances  that 
will  occupy  no  more  space  than  is  necessary  and  also  have 
them  free  from  all  rough  projections.  Very  little  is  required 
to  cause  abrasion  of  or  injury  to  the  soft  tissues  of  the  oral 
cavity,  and  when  once  caused  such  lesions  are  the  source  of 
much  pain. 

■  Least  Interference  with  Speech  and  Mastication. — Most  patients 
apply  to  us  for  correction  of  irregularity  at  a  time  when  their 
education  is  in  progress.  Their  lessons  must  be  recited,  and 
their  enunciation  must  be  distinct  enough  to  be  understood 
by  the  teacher.  With  a  large  and  cumbersome  appliance  in 
the  mouth  it  would  prove  very  difficult  for  them  to  speak 
distinctly,  and  they  would  thus  be  placed  at  a  disadvantage. 

They  are  also  in  their  growing  age  when  the  body  needs 
an  abundance  of  nutritious  food  to  supply  the  demands  of 
the  various  tissues.  If  mastication  be  insufficient  through 
imperfect  occlusion  or  through  tenderness  of  the  teeth  caused 
by  a  bulky  fixture,  nutrition  will  be  inadequate  to  the  needs 
of  the  system. 

Such  conditions  can  and  ought  to  be  avoided  by  a  properly 
constructed  appliance. 


DESIRABLE    QUALITIES.  87 

Cleanliness. — The  cleanliness  of  any  appliance  will  depend 
both  upon  the  method  of  its  construction  and  the  care  that 
is  taken  of  it.  If  it  be  removable  so  that  the  patient  can 
take  it  out,  cleanse  and  reinsert  it,  there  ought  to  be  no 
dijSiculty  about  its  being  kept  clean.  The  patient  should  be 
instructed  to  remove  it  for  cleansing  at  night,  in  the  morn- 
ing, and  after  each  meal,  at  the  same  time  giving  the  natural 
teeth  a  thorough  brushing. 

A  good  plan  is  to  suj^ply  the  patient  with  a  brush,  properly 
marked,  to  be  kept  in  the  office.  When  the  patient  appears 
and  the  appliance  is  removed,  the  operator  should  see  that 
both  plate  and  teeth  are  well  cleansed  in  his  presence.  This 
one  cleansing  he  will  be  sure  of,  though  he  may  not  be  cer- 
tain of  the  others.  The  same  plan  is  pursued  with  plates 
or  appliances  that  can  only  be  removed  by  the  operator. 
Where  appliances  are  of  such  character  that  they  seldom 
need  to  be  disturbed,  the  patient  should  be  taught  to  take  a 
quantity  of  Avater  in  the  mouth,  and  then  using  the  lij3s  and 
cheeks  bellows-fashion,  force  the  water  through  every  inter- 
stice of  the  teeth  and  appliance  to  flush  out  accumulations. 
This  should  be  done  each  time  after  eating  as  well  as  before 
retiring  and  after  rising. 

Most  appliances  can  be  worn  a  long  time  without  injury 
to  tooth  substance,  if  they  are  properly  constructed  and  kejDt 
scrupulously  clean. 

Without  cleanliness,  the  teeth  will  soon  be  injured  by  the 
secretions  and  accumulations,  and  the  breath  of  the  patient, 
from  the  same  cause,  will  become  so  offensive  as  to  disgust 
all  brought  within  its  range. 

Inconspicuousness. — Annoyance  from  wearing  a  conspicu- 
ous appliance  is  often  added  to  the  other  ills  which  the 
patient  is  subjected  to  during  the  process  of  regulation.  An 
appliance  of  this  character,  while  often  producing  distortion 
of  the  lips,  also  attracts  much  attention  and  compels  the 
wearer  to  make  frequent  answers  to  the  same  oft-repeated 
Cjuestion. 

Young  persons  attending  school  or  entering  society  are 


88  ORTHODONTIA. 

naturally  very  sensitive  to  the  ill-appearance  of  any  con- 
spicuous device.  Whenever  the  same  result  can  be  accom- 
plished by  a  concealed  fixture  as  by  an  exposed  one,  it  is 
better  to  adopt  the  former ;  but  where  a  better  or  more 
satisfactory  result  can  be  obtained  by  the  use  of  a  more 
prominent  fixture,  appearance  will  have  to  be  subordinated 
to  utility. 

Stability. — The  quality  of  stability  has  previously  been 
spoken  of,  but  its  real  practical  importance  cannot  be  too 
strongly  insisted  upon.  It  is  a  sine  qua  non  in  orthodontic 
practice.  With  it,  we  have  a  reasonable  certainty  of  results ; 
without  it,  all  is  uncertainty. 

In  some  cases,  as  where  most  or  all  of  the  superior  teeth 
are  to  be  drawn  backward,  we  have  apparently  no  point  for 
proper  anchorage.  Stability  or  fixedness  of  position  for  an 
appliance,  in  such  cases,  not  being  obtainable  within  the 
mouth,  some  fixture  can  be  devised  which  will  have  its  point 
of  resistance  outside,  as  on  the  back  of  the  head. 

This  plan  of  securing  resistance  outside  of  the  mouth, 
has  been  adopted  thus  far  only  in  a  few  exceptional  cases, 
but  it  is  hoped  that  its  advantage  and  importance  will  lead 
to  its  more  frequent  employment  in  the  future. 

Freedom  from  Injury  to  Tooth  Substance. — By  this  we  do  not 
mean  chemical  injury,  for  that  has  already  been  treated  of, 
but  we  refer  to  mechanical  injury.  Any  sharp,  hard  point 
or  roughness  of  a  metallic  appliance,  will  be  likely  to  scratch 
and  mar  the  surface  of  enamel  and  thus  prepare  the  way  for 
future  decay. 

Steel  screw-jacks  of  any  form,  when  placed  directly  against 
the  teeth  of  anchorage  and  those  to  be  moved,  are  liable  to 
work  injury  to  tooth  structure.  For  this  reason  there  should 
always  be  interposed  between  the  teeth  and  screw  some 
material  that  is  non-injurious  to  the  tooth.  Besides  protect- 
ing the  teeth,  such  substance  will  also  serve  to  give  greater 
security  to  the  screw. 

To  obtain  this  same  fixedness  for  the  point  of  a  fish-tail 
screw-jack,  or  other  appliance,  some  operators  have   been 


RETAINING    APPLIANCES.  89 

ill  the  habit  of  drilHng  a  hole  or  depression  in  the  tooth  to 
be  moved.  It  is  hoped  that  the  introduction  of  the  Magill 
band  has  caused  the  abandonment  of  this  practice,  which  at 
best  was  only  justifiable  in  exceptional  cases  and  in  self- 
cleansing  localities. 

RETAINING  APPLIANCES. 

The  retention  m  situ  of  teeth  that  have  been  moved,  for  a 
time  sufficiently  long  to  allow  them  to  become  firm,  is  quite 
as  important  as  the  moving  of  them.  As  previously  explained, 
teeth  become  firm  in  their  new  positions  by  virtue  of  a  deposit 
of  osseous  material  in  the  space  created  by  their  movement. 
The  formation  and  perfect  ossification  of  this  new  material 
is  only  completed  after  a  lapse  of  time  varying  with  the  age 
and  constitution  of  the  individual.  Experience  has  proven 
that  a  less  time  than  six  months  should  never  be  allowed 
for  it,  while  in  persons  of  mature  age  or  in  those  younger 
where .  many  teeth  have  been  involved,  the  time  will  some- 
times have  to  be  extended  to  a  year  or  longer. 

The  natural  tendency  of  a  tooth  to  return  to  its  former 
position,  aided  by  the  tension  of  the  parts  that  have  resisted 
its  movement,  will  certainly  move  a  tooth  from  its  new 
position  unless  the  newly  formed  process  has  become  thor- 
oughly calcified,  and  is  thus  by  its  strength  and  density 
able  to  resist  the  opposing  forces.  Numberless  failures  to 
retain  the  good  results  of  regulation  are  attributable  to  this 
cause  alone. 

In  certain  cases,  as  where  a  superior  incisor  has  been 
occluding  inside  of  the  lower  ones,  or  where  a  lower  one  has 
•  been  biting  outside  of  the  upper  ones,  no  retaining  appliance 
will  be  required  after  it  has  been  brought  into  proper 
position,  because  the  natural  occlusion  of  the  jaws  will  pre- 
vent the  corrected  tooth  from  returning  to  its  former 
position. 

So  also  with  the  bicuspids  and  molars.  Where  mal- 
occlusion has  forced  them  out  of  their  true  position,  or  kept 


90  ORTHODONTIA. 

them  there,  the  correction  of  the  occhision  will  often  tend  to ' 
retain  them  in  their  normal  positions  without  extraneous  aid. 

In  all  other  cases,  however,  mechanical  assistance  will  be 
necessary  until  the  teeth  have  become  firm.  Where  the 
arch  or  any  portion  of  it  has  been  enlarged,  or  where  a  number 
of  teeth  have  been  moved  from  within  outward,  the  simplest 
and  probably  the  best  means  of  retaining  them  will  be  the 
wearing  of  a  thin  rubber  or  metal  plate  covering  the  palatal 
arch  and  nicely  fitting  each  tooth  at  its  neck.  It  may  contain 
a  vacuum-chamber  or  not,  as  preferred,  but  in  many  cases 
the  use  of  one  will  greatly  assist  in  keeping  the  plate  in  place. 
In  addition  to  its  use  in  preventing  teeth  from  moving 
inward,  the  plate  may  often  advantageously  be  modified  by 
the  addition  of  a  gold  hook  or  spur  to  keep  rotated  teeth  in 
position,  or  to  retain  individual  teeth  that  have  been  moved 
inward. 

While  rubber  plates  in  some  form,  either  by  themselves  or 
in  combination  with  accessories,  are  frequently  used  for  retain- 
ing corrected  teeth,  their  use  is,  nevertheless,  open  to  certain 
objections.  All  rubber  plates,  used  either  for  correction  or 
retention,  must  be  removed  at  frequent  intervals  for  cleans- 
ing. The  very  necessity  for  their  removal  affords  opportunity 
for  the  patient  to  remove  them  at  other  times,  and  possibly 
forget  or  wilfully  neglect  to  reinsert  them  for  a  longer  or 
shorter  period,  thus  causing  delay  in  the  reparative  process. 

Besides  this,  also,  in  the  very  act  of  removal  and  insertion 
the  teeth  are  slightly  moved  in  their  sockets  and  this  wdll 
to  a  certain  degree  hinder  the  reformation  of  tissue. 

On  account  of  these  objectionable  features  the  author  has 
for  many  years  avoided  the  use  of  rubber  retaining  plates, 
wherever  he  could  do  without  them.  As  a  substitute  he 
was  led  to  devise  a  number  of  little  appliances  of  gold  and 
platinum,  occupying  the  least  possible  space,  and  firmly 
attached  to  the  teeth  for  the  required  time.  Fig.  28  shows 
one  of  these  appliances  in  its  simplest  form.  It  consists  of  a 
platinum  (Magill)  band,  freely  fitted  to  the  tooth,  and  having 


RETAINING  APPLIANCES. 


91 


The  Author's  Band  and  Bar  Retainer. 


a  gold  bar  or  spur  soldered  to  it  to  press  or'bear  against  one 
or  more  of  the  adjoining  teeth.  When  properly  adjusted,  it 
is  secured  to  the  cor-  Fig.  28. 

rected  tooth  by  means 
of  zinc  phosphate. 

As  will  readily  be 
seen,  its  advantages 
consist  in  its  small 
size,  its  slight  contact 
with  teeth  other  than 
the  one  upon  which 
it  is  placed,  its  clean- 
liness, its  fixedness 
and  the  firmness  with 
which  it  holds  the  corrected  tooth  in  place. 

The  latter  is  its  most  important  feature,  for  it  is  a  well 
recognized  fact  in  surgical  practice  that  re-union  of  bony 
tissue  or  new  formation  of  the  same  will  progress  in  rapidity 
proportionate  to  the  immobility  of  the  parts. 

Fig.  29  shows  a  modification  where  two 
teeth  are  thus  to  be  retained  with  the  exten- 
sion bar  long  enough  to  include  more  dis- 
tant teeth.  Fig.  30  represents  metal  bands 
joined  at  their  points  of  contact,  for  the 
retention  of  two  teeth  that  have  been  rotated. 

Any  number  of  bands  may  be  thus  joined 
to  form  a  retainer  for  a  corresponding  num- 
ber of  teeth,  but  where  they  occupy  so  much 
interdental  space,  the  separations  between  the  teeth  are  very 
unsightly  after  the  retainer  has  been  removed.  A  better 
plan  is  to  employ  but  two  bands,  if  possible,  and  allow 
extensions  from  these  to  support  and  steady  any  intervening- 
ones.  An  illustration  of  one  manner  of  doing  this  is  shown 
in  Fig.  31.  In  this  case  the  two  bands  on  the  cusj)ids  are 
united  by  a  thin  gold  or  platinum  wire  passing  along  and 
conforming  in  outline  to  the  labial  surfaces  of  the  inter- 


FlG-   29. 


Retainer. 


Fig.  30. 
Retainer. 


92 


OETHODONTIA. 


Band  and  ^^lre  Keiamer 


Fig.  32. 


veiling  teeth.     It  was  used  to  retain  three  incisor  teeth  which 
had  been  drawn  inward. 

Pj^  3j  Fig.  32  ilhistrates  a  re- 

tainer of  nearly  similar 
character  for  the  lower 
incisors.  In  this  case  a 
band  of  gold  takes  the 
place  of  the  wire  on  ac- 
count of  its  greater  stiff- 
ness. 

Retaining  appliances  of 
this  character   cannot,  of 
course,  be  used  to  advan- 
tage in  all  cases  ;  but  where 
they  can  they  will  be  found 
to  be  most  satisfactory. 

Fig.  33  represents  a  variety 
of  retainers  constructed  on 
the  band  and  bar  principle, 
showing  numerous  modifica- 
tions. 

Prof.  Angle  uses  a 
retaining    appliance 
differing    from     the 
foregoing  in  having 
a  tube  soldered  par- 
allel with   the  band 
that    encircles     the 
tooth.  The  tooth  once 
in  position  a  wire  is  passed  through  the 
tube  and  made  to  rest  upon  the  adjoin- 
Xf  x^'^^^^pi,"'^  ii^g  teeth,  after  which  a  hole  is  drilled 
\      \-'^  ^^^^^^^  through  both  tube  and  wire  and  a  short 
^_^.^.=^:^E^=.^^  ^^^  inserted  to  prevent  the  wire  from 

shifting  its  position.     See  Fig.  34. 
Another  simple  and  ingenious  device  for  retaining  teeth 
after  they  have  been  moved,  especially  after  rotation,  was 


Retainer  for  Lower  Incisors. 


Retainers 


Fig.  34. 


Angle's  Retainer. 


EETAINIXG  APPLIANCES. 


rs 


Fig    35 


shown  the  author  by  Dr.  H.  A.  Baker.  It  consists  of  a  gold 
screw  cemented  into  some  conveniently  located  cavity  in 
such  a  way  that 
the  protruding 
portion  shall  rest 
against  an  adjoin- 
ing tooth,  and  thus 
prevent  the  tooth 
operated  upon 
from  changing  its 
new  230sition.  Such 
device  could,  of 
course,  only  be 
used  in  rare  and 
exceptional    cases,       "^       "  ■  .v  ,'.,T)^'*"^''' 

1,1  T  Baker's  Retainer. 

but    where    appli- 
cable, it  possesses  the  advantages  of  simplicity,  inconspicu- 
ousness  and  efficiency.     Fig.  35  represents  a  case  in  which  a 
rotated  incisor  was  thus  retained. 

A  very  simple  appliance  for  holding  teeth  which  have  been 
drawn  toward  one  another  is  shown  in 
Fig.  36,  and  was  devised  and  first  used  by 
Prof.  C.  S.  Case.  It  consists  of  a  silver  or 
platinum  wire  passed  over  lugs  or  pins 
upon  bands  attached  to  the  teeth  to  be 
retained.  Floss  silk  or  China-grass  line, 
used  in  the  same  manner  would  answer 
instead  of  wire,  but  it  would  neither  be  as 
strong  nor  as  cleanly.  Prof.  Case  also 
uses  the  wire  for  exerting  a  gentle  tractile 
force  where  needed  by  soldering  a  piece  of 
square  metal  tubing  to  it  at  about  the  middle  of  its  length 
and  turning  this  with  a  suitable  instrimient,  thus  twisting 
the  wires  and  drawing  the  teeth  together. 


Fig.  36. 


CHAPTER  III. 
CONSIDERATION  OF  METHODS. 

farrar's   method. 

In  1876  Dr.  J.  N.  Farrar  began  publishing  a  series  of 
articles  in  the  Dental  Cosmos,  descriptive  of  a  method  he  had 
devised  for  the  regulation  of  teeth.  Reading  and  observa- 
tion, he  said,  had  satisfied  him  that  the  various  plans  sug- 
gested up  to  that  time  for  the  correction  of  irregularity,  were 
lacking  both  in  system  and  principle.  He  claimed  that  the 
performance  of  so  important  an  operation  as  regulation 
should  be  based  upon  a  correct  knowledge  of  both  mechani- 
cal and  physiological  law. 

Experience  had  convinced  him  that  the  character  of  force 
apjolied  to  the  teeth  should  be  positive,  and  that  it  should  be 
intermittent — a  period  of  rest  following  a  period  of  motion. 

The  best  instrument  for  applying  a  force  that  is  positive 
and  may  be  intermittent,  he  said,  was  the  screw  in  one  of  its 
various  forms. 

Experimenting  with  appliances  constructed  upon  the  screw 
principle,  convinced  him  that  this  method  of  delivering  force 
was  not  only  positive  and  direct,  but  also  that  its  range  of 
apf)licability  was  so  great  that  it  might  be  used  to  the  best 
advantage  in  nearly  all  cases  of  regulating.  He  claimed, 
also,  that  it  was  the  only  instrument  whose  force  could  be 
controlled  at  will  and  thus  be  made  to  exert  power  upon  or 
retain  in  a  state  of  repose  the  tooth  or  teeth  operated  upon. 

This  alternation  of  motion  and  rest,  he  stated,  was  as 
important  in  changing  the  positions  of  teeth  as  in  other 
organs  of  the  body  and  was  in  strict  accord  with  physiolo- 
gical law.     In  his  experiments  he  found  that  intermittent 

94 


farrar's  method.  95 

force  was  productive  of  less  pain  to  tlie  jDatient  than  contin- 
uous force,  and  might  be  so  skilfully  applied  as  to  prevent 
all  pain. 

Pain,  he  said,  was  an  expression  of  a  pathological  condi- 
tion, and  by  its  avoidance  we  kept  within  the  boundary 
separating  the  physiological  from  the  pathological  state. 
With  screws  of  known  pitch  and  number  of  threads,  he 
found  that  he  could  move  a  tooth  painlessly,  and  therefore 
safely,  from  ^ro  ^^  two  *^^  ^^  inch  every  twenty-four  hours. 
His  experiments  led  him  to  the  following  conclusions : — * 

"  1st.  That  in  regulating  teeth,  the  traction  must  be  inter- 
mittent, and  must  not  exceed  certain  fixed  limits. 

"2d.  That  while  the  system  of  moving  teeth  by  elastic 
rubber  apparatus  is  unscientific,  leads  to  pain  and  inflamma- 
tion, and  is  dangerous  to  the  future  usefulness  of  the  teeth 
operated  upon,  a  properly  constructed  metallic  apparatus, 
operated  by  screws  and  nuts,  produces  happy  results,  without 
pain  or  nervous  exhaustion. 

"3d.  That  if  teeth  are  moved  through  the  gums  and 
alveolar  i:)rocess  about  ^to  ^^  ^^  ii^ch  every  morning,  and  the 
same  every  evening,  no  pain  or  nervous  exhaustion  follows. 

"  4.th.  That  while  these  tissues  will  allow  an  advancement 
of  a  tooth  at  this  rate  (2-^0"  of  an  inch),  twice  in  twenty-four 
hours,  the  changes  being  physiological,  yet,  if  a  much 
greater  pressure  be  made,  the  tissue  changes  will  become 
pathological." 

The  above  conclusions  were  epitomized  by  him  as  fol- 
lows : — "  In  regulating  teeth,  the  dividing  line  between  the 
production  of  physiological  and  pathological  changes  in 
the  tissues  of  the  jaw  is  found  to  lie  within  a  movement  of 
the  teeth  acted  upon,  allowing  a  variation  which  will  cover 
all  cases,  not  exceeding  2^  or  -j^  of  an  inch  every  twelve 
hours." 

*  Dental  Cosmo.%  Vol.  XVIII.,  p   28. 


96  ORTHODONTIA. 

His  articles  upon  the  subject  may  be  found  in  the  Dental 
Cosmos,  extending  from  A^ol.  XVIII.  to  XXIV. 

Although  the  screw  principle  was  the  one  which  he  prin- 
cipally used,  and  the  only  one  which  he  considered  scientifi- 
cally and  phj^siologically  correct,  he  at  times  availed  himself 
of  the  use  of  some  of  the  continuous-force  appliances,  such 
as  rubber  bands,*  silk  or  fibre  ligatures,t  and,  for  the  attach- 
ment of  appliances,  vulcanite  plates.J 

The  multiplicity  and  variety  of  Dr.  Farrar's  appliances 
and  the  ingenuity  displayed  in  their  devising,  have  com- 
manded the  admiration  of  all  and  been  of  great  value  to 
laborers  in  this  field.  Most  of  his  devices  are  original  in 
design,  and  well  calculated  to  perform  the  work  intended, 
but  in  confining  himself  so  largely  to  the  use  of  one  form  of 
power-producing  instrument  his  apparatus  is  in  many  cases 
very  elaborate  and  complicated.  The  same  end  could  often 
be  accomplished  by  much  simpler  means. 

His  appliances  are  so  numerous  that  illustrations  of  many 
of  them  could  not  be  introduced  into  a  text  book,  nor  could 
they  well  be  selected  from  to  illustrate  his  principles,  but 
some  of  them  may  be  found  in  Part  III.,  where  the  practical 
treatment  of  various  forms  of  irregularit}^  is  considered. 

Dr.  Farrar  has  recently  published  in  book  form  a  full 
elaboration  of  his  views  and  methods,  together  with  numer- 
ous illustrations  of  his  appliances,  to  which  the  reader  is 
referred. 

THE    MAGILL    BAND. 

This  device,  while  not  j^roperly  constituting  a  method,  is 
considered  here,  because  through  its  great  value  it  has  come 
to  be  an  important  factor  in  several  methods  of  regulating 
devised  since  its  introduction.  Dr.  W.  E.  Magill,  having  in 
common  with  other  practitioners  experienced  the  difficulty 


*  Cosmos,  Vol.  XIX.,  p.  520. 
t       "  "     XXI.,   "  306. 

t       "  "     XXI.,   "  306. 


MAGILL    BAND. 


97 


of  attaching  regulating  appliances  to  the  natural  teeth  in 
such  a  way  that  they  would  have  a  firm  hold  and  not  slip, 
devised  the  following  plan  of  meeting  and  overcoming  the 
difficulty : — 

From  a  piece  of  platinum,  German  silver  or  platinous 
silver  plate.  No.  28  (B.  and  S.)  gauge  in  thickness,  he  cut  a 
strip  about  a  line  in  width  and  bending  it  to  conform  to  the 
shape  of  the  tooth  soldered  it  at  the  point  where  the  ends 
overlapped,  thus  converting  it  into  a  band  or  ferrule.  After 
attaching  to  this  band  any  studs,  pins  or  hooks  that  the 
case  demanded  it  was  lined  with  oxy-chloride  of  zinc  and 
slipped  over  the  dried  tooth  to  a  point  about  midway  between 
the  cutting  edge  and  neck. 

Since  the  introduction  of  phosphate  of  zinc,  it  has  been 
found  to  be  a  far  better  medium  for  the  attachment  of  the 
band  to  the  tooth  than  the  oxy-chloride  of  zinc,  formerly 
used.  Once  in  position,  the  cement  will  harden  in  about 
five  minutes,  after  which  no  ordinary  force  will  be  able  to 
dislodge  it.  If  a  wire  spring  is  intended  to  rest  against  and 
press  upon  a  banded  tooth,  a  hole  or  pit  should  be  drilled  in 
the  band  at  a  suitable  point,  before  it  is  cemented  in  place. 
If  rubber  bands  or  ligatures  are  to  be  employed,  suitable 
provision  for  their  easy  attachment  may  be  made  by  pre- 
viously soldering  to  the  band  a  small  gold  hook  or  a  headed 
platinum  pin  taken  from  a  porcelain  tooth.  Where  a  screw- 
jack  is  to  be  used  in  the  moving  of  a  tooth,  an  abutment 
of  platinum  should  be  soldered  to  the. band  encircling  the 
resisting  tooth,  and  then  be  slotted  to  receive  one  end  of  the 
screw.  The  band  of  the  tooth  to  be  moved  should  also 
be  reenforced  and  drilled  to  accommodate  the  point  of  the 
screw. 

When  the  operation  is  completed,  or  when  for  any  cause  it 
may  be  desired  to  remove  the  band,  it  is  easily  accomplished 
by  protecting  the  enamel  at  the  cutting  edge  of  the  tooth 
wdth  a  folded  napkin  or  piece  of  chamois  skin,  and  placing 
one  beak  of  a  pair  of  pliers  upon  it  and  the  other  upon  the 


98  ORTHODOXTIA. 

upper  edge  of  the  band,  the  closure  of  the  hand  will  dis- 
lodge the  appliance  without  in  the  least  marring  or  altering 
its  form.  By  this  simple  inA'ention  one  of  the  greatest  diffi- 
culties hitherto  experienced  in  regulating  has .  been  over- 
come, and  its  devising  has  almost  introduced  a  new  era  in 
regulating.  For  the  purpose  Intended  there  is  nothing  that 
approaches  it  in  efficiency. 

Before  its  introduction  attachment  to  the  tooth  to  be 
moved  was  usually  efi^ected  by  means  of  a  ligature  ingeni- 
ously applied  and  made  fast  by  some  form  of  knot,  or  a  pit 
or  hole  was  drilled  into  the  substance  of  the  tooth  to  receive 
the  point  of  a  screw  or  other  device  and  prevent  it  from 
slipping.  The  knots  would  often  slip  and  the  drilling  of 
pits  was  objectionable,  so  that  the  difficulties  of  securement 
w^ere  not  overcome  until  the  invention  of  this  band. 

By  its  use  absolutely  secure  attachment  and  anchorage  are 
obtained  and  the  moving  of  teeth  is  accomplished  with  far 
greater  exactness  than  had  jDreviously  been  possible.  When 
attachment  was  made  by  ligature  it  was  often  necessary 
that  the  ligature  should  encircle  the  tooth  at  its  neck,  and 
when  not  necessary  to  place  it  there  it  would  often  slip  into 
that  position  owing  to  the  shape  of  the  tooth.  The  irrita- 
tion of  the  soft  tissues  thus  produced  was  frequently  the 
cause  of  much  pain  to  the  patient.  The  Magill  band  obviates 
this  by  preventing  any  fixtures  attached  to  it  from  coming 
in  contact  with  the  delicate  and  sensitive  mucous  membrane 
of  the  gum. 

Indeed,  the  author  has  found  that  by  its  use  nearly  all  the 
pain  of  regulating  has  been  done  away  with,  for  the  pain 
attendant  upon  regulating  by  the  old  methods  was  caused 
not  so  much  by  the  slight  irritation  induced  by  the  moving 
tooth  as  by  the  imj)ingement  of  ligatures,  rubber  bands  and 
other  appliances  upon  the  soft  tissues.  The  Magill  band  may 
therefore,  we  think,  be  credited  with  having  done  more  to 
modify  the  pain  accompanying  regulation  than  any  other 
device  ever  introduced. 


angle's  method.  99 

In  some  methods  of  regulating,  such  as  Farrar's  and 
Angle's,  attachment  is  made  to  the  teeth  by  means  of  an 
open  band  of  gold  secured  to  the  teeth  by  a  nut  and  bolt 
operating  upon  the  free  ends  of  the  band.  Such  device, 
while  valuable,  is  more  complicated,  cumbersome  and  less 
cleanly  than  the  Magill  band.  It  is  also  open  to  the  objec- 
tion previously  noted,  that  of  allowing  the  secretions  to 
remain  between  the  tooth  and  band. 

Several  of  the  author's  methods  of  modifying  the  form  of 
the  band  by  means  of  attachments  to  increase  its  usefulness, 
are  illustrated  in  Part  III. 

angle's  method. 

This  method  of  regulating  was  first  brought  to  the  notice 
of  the  profession  by  its  originator,  Prof.  Edward  H.  Angle, 
in  a  paper  read  before  the  dental  section  of  the  Ninth  Inter- 
national Medical  Congress,  held  in  Washington,  D.  C, 
September,  1887. 

The  apiDliances  used  are  mostly  made  from  German  silver, 
although  the  levers  are  of  steel  and  the  retaining  wire  of 
gold.  German  silver  is  strong,  easily  adapted  and  inexpen- 
sive, while  the  steel  piano-wire  combines  strength  and  elas- 
ticity with  lightness  and  delicacy. 

Power  is  obtained  by  the  well-known  mechanical  prin- 
ciples of  the  screw  and  spring,  while  support  or  resistance  is 
gained  by  firmly  attaching  the  parts  to  the  teeth  by  the 
Magill  band,  which  is  cemented  in  place,  or  by  an  adjust- 
able clamp  band. 

The  appliances  are  few  in  number,  simple  in  design,  and 
easily  applied ;  qualities  that  add  materially  to  the  value  of 
any  device  for  general  use.  Prof.  Angle,  in  describing  his 
method,  says : — 

"  Fig.  37  shows  the  simple  appliances  from  which  all  the 
various  combinations  used  in  the  original  method  may  be 
made.     "  A  "  is  a  large  traction  screw  encased  in  its  accom- 


11. 0 


ORTHODONTIA. 


jjanying  tube,  and  used  for  pulling  where  the  resistance  is 
great.  "  B  "  is  a  smaller  traction  screw,  used  in  the  same 
way  where  the  resistance  is  slight,  or  where  from  any  reason 
a  delicate  appliance  is  desired.  "  C  "  and  "  D  "  are  tubes 
which  are  soldered  to  bands  placed  upon  the  teeth  to  be 
moved,  into  which  the  ends  of  the  traction  screws  are 
hooked.  "  J  "  is  a  jack-screw,  used  for  pushing,  the  end  of 
which  is  beaten  flat.  "  E  "  is  an  extra  piece  of  tubing,  by 
nuans  of  which  a  longer  jack-screw  can  be  made.  "  F  "  and 
"  H  "  are  coils  of  band  material  of  different  thicknesses.  "  G  " 
is  a  gold  wire  used  in  retaining  the  teeth  and  also  to  assist 

Fig.  37. 


Angle's  Appliances. 

in  securing  anchorage  in  some  cases,  and  "  RR  "  are  small 
retaining  tubes,  into  which  the  retaining  wire  accurately 
fits,  and  are  designed  to  be  soldered  to  bands.  "  LL  "  are 
lengths  of  piano-wire  of  varying  sizes,  giving  different 
degrees  of  power. 

"  Aside  from  the  advantages  of  simplicity,  efliciency  and 
cleanliness,  which  are  insured  by  these  appliances,  a  still 
greater  desideratum  is  gained  by  means  of  the  mechanical 
principles  observed  in  their  construction.  Stationary  an- 
chorage and  non-relinquishment  of  pressure  are  prominent 
features  of  this  method,  and  are  certainly  secured  almost  to 
perfection. 


ANGLE  S    METHOD. 


101 


"  A  few  of  the  principal  movements  are  selected  for  illus- 
tration from  the  many  modifications  of  which  the  appliances 
are  capable. 

"The  application  and  operation  of  the  direct  screw  is 
shown  in  Fig.  38.  A  firm  anchorage  for  the  resistance  of 
the  screw  is  obtained  by  banding  and  tubing  the  left 
cuspid,    and  passing  Fig   38 

through   the  tube   a 
piece  of  gold  or  Ger- 
man silver  wire  long 
enough  to  extend  to 
and  rest  against  ad- 
joining  teeth.      The 
opposite     cuspid     is 
banded,  and  a  retain-  p 
ing  tube  soldered  tO''|4:s= 
the     labial     surface,  f^^^p" 
The  lingual    surface 

has  a  slot  cut  in  it  to  Re-eaforced  Anchorage.   (Angle.) 

receive  the  flat  end  of  the  screw-jack.  The  other  end  of 
the  tube,  in  which  the  screw  plays,  is  so  filed  that  it  rests 
securely  against  the  reenforcement  wire  and  the  tube  upon 
the  lingual  surface  of  the 
cuspid  band.  After  being 
brought  into  position  the 
tooth  is  held  in  place  by  pass- 
ing a  short  piece  of  gold  wire 
through  the  retaining  tube 
on  the  labial  surface,  which  is 
left  in  place  until  the  tooth 
is  firmly  set  in  its  new  posi- 
tion. 

"  The  backward  movement 
of  teeth   in  the  line   of  the 
arch  is  accomplished  by  the 
appliance  shown   in  Fig.   39. 
first    molar    are    banded,    and 


Fig.  39. 


iiili 

Retraction  of  Cuspid.    (Angle.) 

The   second   bicuspid   and 
the     tube    of    the    heavv 


102 


OKTHODONTIA. 


Fig.  40. 


tr.ictioii  screw  rigidly  soldered  to  the  bands.  The  cuspid 
to  be  moved  is  banded,  and  a  short  section  of  tubing 
soldered  to  it  to  receive  the  end  of  the  traction  screw. 

On  turning  the  nut  traction  is  produced  and  the  cuspid 
drawn  into  place.  The  cuspid  is  kept  from  being  rotated 
while  it  is  being  moved  backward,  by  means  of  the  short 
tube  accurately  fitting  the  right-angled  end  of  the  traction 
screw. 

"  Another  outward  movement  of  a  tooth  by  means  of  the 

screw-jack  is  shown  in 
Eig.  40.  The  second  bi- 
cuspid is  made  the  princi- 
pal anchorage,  against 
which  the  base  of  the  tube 
rests.  The  band  encircling 
the  lateral  incisor  has  a 
slot  cut  in  it  to  receive  the 
end  of  the  screw-jack.  The 
anchorage  is  reenforced  by 
means  of  a  wire  loop,  which  hooks  into  tubes  upon  the  adjoin- 
ing central  and  cuspid,  and  is  looped  over  a  spur  upon  the 
body  of  the  screw-jack  tube.  The  central  and  cuspid  cannot 
be  pushed  outward  on  account  of  this  reenforcement,  and 
three   teeth  constitute  the  anchorage  instead  of  one.     The 

several  parts  of  this  appliance  are 
shown  in  Fig.  41. 

"  Outward  movement,  as  accom- 
plished by  another  simple  means, 
is  as  follows :  A  thin  strip  of  band 
°  material  is  looped  about  the  mal- 
posed  tooth,  the  ends  resting  upon  the  labial  surfaces  of  the 
adjoining  teeth.  To  one  end  of  this  strip  is  soldered  a  tube 
placed  vertically,  while  to  the  other  end  a  similar  tube  is 
attached  horizontally.  Into  these  tubes  the  small  traction 
screw  is  placed,  being  bent  to  conform  to  the  shaj)e  of  the 
arch,  and  used  in  this  case  to  push  instead  of  pull.     The 


iprocal  Anchorage.    (Angle.) 


Fig.  41. 


ANGLE  S    METHOD. 


103 


Device  for  Lateral 
Movement. 


Fig.  43. 


Retendou. 


parts  of  this  device  are  shown  separately  in  Fig.  42.  The 
manner  of  retaining  the  teetli  in  position,  after  correction, 
is  shown  in  Fig.  43. 

"  Rotation  by  this  method,  as  in  most  others,  is  accom- 
plished by  the  elasticity  of  a  metallic  bar  or 
wire  attached  to  the  tooth  to  be  rotated,  and 
then  sprung  around  to  some  firmer  tooth  or 
teeth  at  a  distance.  Fig.  44  shows  a  lateral 
to  be  rotated,  and  the  appliance  in  position 
by  which  it  may  be  accomplished.  The 
lateral  is  banded  and  tubed  as  shown  in  the 
cut.  The  second  bicuspid  is  also  banded, 
and  to  secure  greater  resistance,  the  two 
adjoining  teeth  are  made  to  assist  by  means 
of  a  wire  which  passes  through  a  tube  on  the 
palatine  surface  and  rests  against  the  first  bicuspid  and  first 
molar.  On  the  buccal  side  of  this  same  band,  the  ends  of 
the  band  material  are  shaped  into  a 
latch  or  hook,  with  which  the  rotating 
spring  engages  when  it  is  sprung 
around.  The  several  parts  of  this 
appliance  are  shown  in  Fig.  45. 
After  the  tooth  is  in  j^osition,  it  is 
retained  by  means  of  a  short  wire 
passing  through  the  tube,  and  ex- 
tending upon  the  central,  as  seen  in 
Fig.  46.  This  wire  is  kept  in  place 
by  a  small  pin,  which  is  tightly  fitted 
in  a  small  hole  drilled  through  both  tube  and  wire,  as  shown. 

"  When  two  teeth  are  to  be  rotated  in  opposite  directions 
at  the  same  time,  as  the 
central  incisors,  double 
rotation  may  be  accom- 
plished by  one  appliance, 
as  shown  in  Fig.  47.  Both 
teeth    are  banded,  and  a 


Fig.  44. 


Rotation.    (Angle.) 


Fig.  45. 


104 


ORTHODONTIA. 


Fig.  46. 


Retainer. 


Fig.  47. 


Double  Rotation.  (Angle.) 
Fig.  48. 


tube  soldered  to  each  band,  one  being  horizontal  and  the' 
other  vertical.  A  piece  of  piano-wire  is  bent  to  a  right  angle 
at  one  end,  and  then  placed  in  position  as 
seen  in  Fig.  48.  The  tendency  of  the  wire 
to  straighten  itself,  will  rotate  both  teeth 
at  once.  When  in  position  they  are 
retained  by  substituting  a  non-elastic  gold 
wire  for  the  piano-wire. 

"  Expansion  of  the  arch  is  accom- 
plished by  banding  and  tubing  the 
first  and  last   teeth   of  those   to  be 
moved,  on  each  side,  and  connecting 
them    by    means    of  a  wire   passed 
through  the  tubes.    To  these  wires, 
at  suitable  and  varying  distances, 
are  soldered  short  tubes  to  accom- 
modate the  ends  of  the  piano-wire 
spring  which  is  bent  to   conform 
somewhat  to  the  shajDC  of  the  arch, 
■pj.^   ^g  While  the  spring  does 

,_.        ^  not  give  us  the  power 

and  direct  action  of  the 
screw-jack,  it  is  in  many 
cases  sufficient  and 
avoids  interference  with 
the  tongue. 

"  Fig.  49  shows  the 
appliance  iu  position, 
which  is  as  applicable 
to  the  lower  teeth  as 
the  upper." 

Retention  is  antici- 
pated and  provided  for, 
by  means  of  the  tubed 
band,  while  the  pin  device  for  locking  spring  and  tube 
together,  is  both  novel  and  ingenious.     Aside  from  these, 


Double  Rotation.    (Angle.) 


Angle  Device  for  Expansion. 


coffin's  method.  105 

the  method  contains  so  many  ingenious  modifications  of 
previously  known  devices  (as  tlie  screw  and  band),  and  is 
composed  of  parts  so  simple  and  direct  in  their  action,  that 
it  must  necessarily  commend  itself  to  all  engaged  in  this  line 
of  practice.  Other  illustrations  of  this  method  are  shown 
throughout  Part  III. 

The  various  parts  of  the  Angle  appliances  may  be  obtained 
from  dental  supply  houses. 

coffin's  method. 

In  a  paper  read  before  the  Dental  Section  of  the  Inter- 
national Medical  Congress,  held  in  London,  in  August,  1881, 
Mr.  Walter  H.  Coffin  explained  his  method  of  correcting 
irregularity  of  the  teeth.  The  method  was  devised  by  his 
father,  and  had  been  in  use  by  father  and  son  for  twenty- 
five  years.  It  was  termed  the  "  Expansion  Method,"  because 
in  nearl}^  all  cases  coming  under  their  care  a  certain  amount 
of  expansion  had  been  found  necessary  in  connection  with 
other  desired  movements. 

The  construction  of  the  appliance  and  the  principle 
upon  which  it  acts  are  exceedingly  simple.  The  power  is 
derived  from  the  elasticity  of  piano-forte  wire,  attached  in 
various  ways  to  a  vulcanite  plate  which  covers  the  arch  (in 
an  upper  case)  and  envelopes  the  posterior  teeth  on  either 
side  to  give  it  firmness  and  fixedness  in  position.  When  it 
is  desired  to  expand  the  superior  arch,  the  wire  is  bent  into 
the  form  of  a  double  U,  lying  on  top  of  the  plate  with  the 
ends  embedded  in  it. 

To  produce  lateral  expansion  in  the  lower  jaw,  the  form 
of  the  appliance  is  necessarily  different.  A  simple  vulcanite 
plate  is  made  in  horse-shoe  form,  fitting  the  gum  and  lingual 
surfaces  of  the  teeth,  and  capping  the  molars  and  bicus- 
pids. On  the  lingual  surface  of  this  plate,  lie  two  pieces  of 
piano-wire  suitably  curved,  with  their  ends  embedded  in 
the  rubber. 


106  ORTHODONTIA. 

Each  of  these  plates,  when  completed,  is  sawn  in  two  along' 
the  median  line,  thus  allowing  the  tension  of  the  wire  to  be 
increased  from  time  to  time  by  spreading  apart  the  sections 
of  the  plate. 

The  piano  wire  used  may  be  obtained  from  j)iano  fac- 
tories or  from  dealers  in  dental  supplies.  It  is  made  from 
the  best  quality  of  steel,  drawn  to  size  through  draw-plates. 
The  quality  of  the  steel,  as  well  as  the  toughness  of  the  wire, 
is  greatly  improved  by  the  successive  drawings  to  which  it 
has  been  subjected.  For  ordinary  cases  Mr.  Coffin  recom- 
mends that  the  diameter  of  the  wire  be  between  three  and 
four  one-hundredths  of  an  inch.  A  lighter  or  heavier  num- 
ber will  yield  respectively  less  or  greater  pressure. 

In  use  it  should  not  be  annealed,  but  bent  to  shape  as  it 
comes.  Mr.  Coffin  recommends  that  the  wire  be  tinned 
after  being  bent  to  shape,  to  prevent  oxidation  in  the 
mouth,  but  this  does  not  appear  to  be  necessary. 

A  wire  suitably  bent  to  produce  expansion  of  the  superior 
arch  is  represented  by  Fig.  50. 

The  details  of  the  construction  of  an  expansion  plate  for 
the  superior  jaw,  are  as  follows  :  From  an  accurate  impres- 
sion of  the  jaw  and  teeth,  taken  with  plaster  or  modelling 
Fig.  50.  compound,   a   plaster  model    is    ob- 

tained. Upon  this  a  wax  base-plate 
is  fashioned,  to  cover  all  parts  in- 
tended to  be  covered  by  the  com- 
pleted plate.  The  suitably  bent  wire 
is  now  further  shaped  so  that  it  will 
Co  n  spimg.  y[q  upon  the  exposed  surface  of  the 

base-plate  and  conform  to  it  as  closely  as  possible  in  outline. 
After  the  ends  of  the  wire  are  attached  to  the  base-plate  by 
means  of  additional  wax,  a  piece  of  tin-foil  (No.  60)  is 
slipped  between  the  wire  and  the  plate  and  its  corners 
bent,  so  that  the  plaster  when  poured  into  the  flask  will 
grasp  and  remove  it  with  the  wire.  The  foil  is  placed  there 
so  that  the  plate  will  have  a  polished  surface  under  the  wire 


coffin's  method.  107 

after  vulcanization.  The  wax  base-plate  should  now  be 
smoothed  with  a  spatula  and  flasked  in  the  usual  manner. 
In  separating  the  flask,  the  wire  and  tin-foil  will  come 
away  with  the  upper  half,  while  the  model  will  remain  in 
the  lower.  After  removing  the  wax  and  packing  the 
rubber,  the  case  is  vulcanized,  after  which  it  is  polished. 
The  completed  piece  should  now  be  properly  fitted  to  the 
patient's  mouth,  and  the  rubber  covering  the  masticating 
surfaces  of  the  posterior  teeth  so  filed  and  dressed  that  the 
cusps  of  the  occluding  teeth  will  all  strike  the  rubber  at  the 
same  time. 

However  many  or  few  of  the  natural  teeth  be  covered  the 
last  ones  in  the  arch  must  always  be  included,  as  otherwise 
they  will  elongate  through  non-occlusion  and  thus  seri- 
ously impair  the  usefulness  of  the  masticatory  apparatus. 
After  the  plate  has  been  fitted  it  should  be  sawn  in  two  with 
a  jeweler's  fine  saw,  the  edges  made  smooth  and  slightly 
rounded,  and  the  case  introduced  into  the  mouth. 

It  is  desirable  to  have  the  patient  wear  the  plate  for  a  clay 
without  enlargement,  after  which,  at  intervals  of  a  day 
or  two,  the  tension  of  the  wires  should  be  increased  by 
pulling  the  halves  of  the  plate  apart  sufficiently  to  slightly 
increase  the  space  between  them.  When  the  wire  is  heavy, 
as  is  necessary  where  great  force  is  to  be  exerted,  it  can  be 
best  formed  into  shape  and  afterwards  altered  as  required 
by  means  of  the  ordinary  clasp-bending  pliers.  The  con- 
struction of  the  lower  plate  is  substantially  the  same,  but 
the  wires  lie  against  the  plate  in  a  continuous  smooth  curve, 
instead  of  being  corrugated. 

Figs.  51  and  52  represent  an  upper  and  lower  expansion 
plate  as  described.  For  cases  where  expansion  is  not 
needed,  but  simply  the  moving  of  one  or  more  teeth,  Mr. 
Coffin  uses  a  solid  rubber  plate  with  wires  so  placed  as  to 
produce  the  desired  movements.  The  construction  of  this 
form  of  plate  is  the  same  as  those  just  described,  with  the 
exception  of  the  shape  and  arrangement  of  the  wires  and 
the  non-separation  of  the  plate. 


108 


ORTHODONTIA. 


A  single  long  piece  of  wire,  bent  at  right  angles  near  one' 
end  and  flattened  at  the  other,  is  embedded  at  its  flattened 
end  into  the  plate,  while  the  other  end,  and  a  long  portion 
besides  is  free  and  lies  in  close  contact  with  the  plate- 
Before  the  wire  is  attached  to  the  wax  base-plate,  the  plaster 
tooth  representing  the  one  to  be  moved  should  be  cut  away- 
close  to  its  neck  and  the  bent  end  of  the  wire  laid  upon  it 
so  as  to  cover  the  entire  diameter  of  the  stub  tooth.  In  this 
Fig.  51.  position  it  is  vul- 

canized   to    the 
plate. 

When  the  plate 
is  introduced,  the 
wire  will  have  to 
be  drawn  back 
with  an  i  n  s  t  r  u- 
ment  or  string  be- 
fore the  plate  will 
go  into  position. 
Once  in  place  and 
the  wire  released 
continuous  pres- 
sure will  be  exert- 
ed on  the  malposed 
tooth.  After  the 
tension  of  the  wire 
has  been  lessened 
by  the  moving  of 
the  tooth,  it  may- 
be increased  either  by  bending  the  wire  where  it  enters  the 
plate  or  by  cutting  it '  out  and  re-setting  in  a  different 
position. 

Another  and  very  convenient  way  of  lengthening  the 
wires  to  follow  the  moving  tooth,  is  to  slip  a  eection  of  plati- 
num or  German  silver  tubing  over  the  end  of  the  wire  and 
soft-solder  it  in  position. 


Fig.  52 


Coffin's  Expansion  Plates. 


COFFIN  S    METHOD. 


109 


Where  a  tooth  is  to  be  pressed  outward  the  wire  is 
anchored  in  the  palatal  portion  of  the  plate,  but  where  a 
tooth  is  to  be  moved  from  without  inward,  the  wire  should 
be  attached  to  that  portion  of  the  plate  covering  the  buccal 
surfaces  of  the  molars. 

Rotation  is  accomplished  by  combining  the  two  move- 
ments ;  that  is,  by  having  one  wire  on  the  palatine  surface 
to  press  against  one  angle  of  the  tooth,  and  another  on  the 
buccal  surface  to  press  against  the  opposite  angle. 

Two  wires  can  be  inserted  to  operate  on  two  teeth  at  the 
same  time,  either  in  similar  or  opposite  directions.  Fig.  53 
represents  a  plate  made  to  press  outward  two  lateral  incisors. 

Many  modifications  of  the  Coffin  plate  have  been  devised 
by  different  practitioners,  some  of  which  are  shown  in 
Part  III. 

The    originator    claims  ^^^'  ^^' 

for  his  method  and  appli- 
ance, simplicity,  ease  of 
construction  and  inexpen- 
siveness,  almost  universal 
range  of  application,  per- 
fect control  offeree  applied 
and  direct  action,  com- 
parative i3ainlessness  from 
non-irritation  of  the  soft 
tissues,    perfect    fixedness 

and  least  unsightliness,  ease  of  removal  for   cleansing,  and 
little  interference  with  speech  and  mastication. 

Jackson's  method. 

Appreciating  the  values  of  piano-wire  as  a  power-yielding 
material,  as  shown  in  the  Coffin  method,  and  realizing  the 
advantage  in  most  cases  of  dispensing  with  the  use  of  a 
plate,  Dr.  V.  H.  Jackson  was  led  to  devise  a  method  of  con- 
structing regulating  appliances  in  which  piano-wire  was  the 
principal  and  almost  the  only  material  employed. 


Coffin  Solid  Plate. 


110 


ORTHODONTIA. 


By  suitably  bending  a  length  of  this  wire,  of  medium 
thickness,  in  such  a  way  as  to  pass  around  the  buccal  and 
lingual  surfaces  of  all  the  teeth  in  one  of  the  arches  and 
joining  these  portions  at  convenient  distances  by  short  con- 
necting wires,  a  "  crib  "  or  skeleton-wire  fixture  was  formed 
that  hugged  the  teeth  and  held  itself  firmly  in  place. 

To  this,  as  a  foundation,  additional  wires  were  attached  of 
such  length  and  shape  as  to  bear  and  produce  pressure  upon 
any  teeth  in  the  same  arch  which  it  was  desired  to  bring  into 
proper  position. 

Fig.  54  shows  the  general  appearance  of  the  "  crib  "  in 
its  simplest  form. 

In   constructing  the  appliance,  the  plaster   teeth   of  the 

model  are  first  scraj)ed 
near  their  necks  on  both 
the  buccal  and  lingual 
surfaces  so  that  the  crib, 
when  formed,  will  have 
to  be  sprung  into  place. 
The  wire  is  now  bent 
by  means  of  flat-  and 
round-nosed  pliers  so  as 
to  conform  to  the  out- 
line of  the  teeth  and 
touch  all  of  the  includ- 

( Jackson.) 


Crib. 


ed  ones  at  their  necks. 
To  keep  the  crib  from  impinging  upon  and  irritating  the 
gum,  short  wires  (as  before  stated)  are  formed  to  lie  in  the 
depressions  between  the  masticating  surfaces  of  certain  teeth 
and  are  attached  to  the  main  wire  upon  both  the  buccal  and 
lingual  sides.  These  connecting  wires  are  joined  to  the  base 
wire  by  having  their  ends  bent  so  as  to  grasp  them,  after 
which  the  joints  are  secured  by  means  of  soft-solder  fused 
either  by  the  blow-pipe  or  soldering  iron  while  the  parts  are  in 
position  on  the  model.  Before  soldering,  the  joints  will 
have  to  be  touched  with  dilute  muriate  of  zinc,  commonly 


JACKSON  S    METHOD. 


Ill 


known  as  soldering  fluid.  Wrapping  the  joint  with  thin 
copper  strips  as  shown  in  Fig.  55,  before  soldering  greatly 
facilitates  the  operation. 

The  crib  once  projDerly  formed,  additional  wires  for  pro- 
ducing   pressure    at  ^  yig.  55 
any  point  and  in  any 
desired  direction  are 
added  to  it  in    the 


Fig.  56. 


same  manner. 

Fig.   56    shows    a 
crib  formed  for  and 

attached  to  but  one  side  of  the  arch  for  the  purpose  of 
forcing  a  cuspid  outward  and  a  lateral  inward  into  line  at 
the  same  time. 

In  some  cases  the  end  of  the  wire  producing  pressure  is 
best  secured  in  position  by  being  soldered  to  a  band  to  be 
cemented  to  the  tooth  to  be  moved,  as 
shown  in  Fig.  57. 

While  the  appliance  thus  constructed 
is  firmly  held  in  place  by  hugging  the 
teeth  above  their  most  prominent  por- 
tions it  is  at  the  same  time  readily  re- 
moved for  the  purpose  of  bending  the 
wire  springs  or  for  alterations  or  new 
attachments. 

Dr.  Jackson  has  simplified  and  im- 
proved his  api^liances  by  discarding 
the  crib  formed  of  a  continuous  piece 
of  wire  (which  w^as  oftentimes  difficult 
to  construct)  and  obtaining  his  anchorage  by  wire  and 
metal  attachments  to  individual  teeth  instead,  as  shown  in 
Fig.  58. 

In  constructing  these  anchorage  appliances,  he  first  cuts 
from  thin  gold,  block  tin,  tinned  copper,  German  silver  or 
Tagger's  tin  a  piece  large  enough  to  cover  the  lingual  por- 
tion of  the  anchor  tooth  and  contours  it  with  the  contouring 


Side  Crib      (Jackson  ) 


112 


ORTHODONTIA. 


Fig.  58. 


pliers  used  in  crown-  and  bridge-work.     A  wire  crib  for  the 
Fig.  57.  same  tooth  is  then  made 

from  a  piece  of  No.  20 
piano- wire  by  "  first  bend- 
ing it  at  right  angles  (Fig. 
59),  leaving  the  width  be- 
tween the  parallel  sides 
equal  to  the  antero-poste- 
rior  width  of  the  tooth  to 
be  clasped.  The  part  that 
is  to  clas]3  the  neck  of  the 
tooth  is  then  so  bent  with 

Crib  and  Band     (Jackson )  claSp-bcndcrS    that   it   wiU 

be  perfectly  adapted  to  the  curve  of  the  labial  side  of  the 
tooth.  (Fig.  60.)  Both  arms  of  the  wire  are  then  bent  at 
nearly  a  right  angle  at 
a  proper  distance  to 
cause  them  to  pass  over 
the  grinding  surface  of 
the  tooth,  and  again 
bent  in  the  same  man- 
ner to  extend  toward 
the  neck  of  the  tooth  on 
the  lingual  side.  Fig.  61. 
"The  ends  are  next 
bent  toward  each  other 
near  the  gum  line  over 
the  piece  of  metal  pre- 
viously described,  as  seen  at  A  in  Fig.  58,  and  tacked  with 
Fig.  59.         soft  solder." 

If  the  wire  spring  is  to  be  attached  to  the 
teeth  on  the  opposite  side  of  the  arch  a  sim- 
ilarly constructed  crib  should  be  made  for 
that  side.  With  these  two  cribs  in  place 
on  the  plaster  model  the  connecting  wire,  after  being  suit- 
ably shaped,  is  laid  in  position  and  firmly  held  while  all  are 


Anchorage.    (Jackson.) 


JACKSON  S    METHOD. 


113 


Fig.  61. 


joined  together  with  solder.  The  soldering  is  most  con- 
veniently accomplished  by  moistening  the  parts  with  dilute 
muriate  of   zinc,  laying  upon  each  joint  a  ^ig.  60. 

piece  of  soft  solder  of  suitable  size  and  fusing 
with  a  soldering  iron.  After  this  any  wire 
springs  that  may  be  needed  are  attached  in 
the  same  manner. 

The  entire  appliance  being  thus  formed  of 
separate  parts  and  joined  together  while  in 
position  on  the  model  assures  accuracy  of  fit 
that  could  not  well  be  obtained  in  any  other 
manner. 

In   other   cases,  where  it  seems   advisable,   instead  of  a 

crib  made  of  plate  and  wire  as  described,  attachment  to  the 

anchor  teeth  is  made  by  means  of  a  metal  band    or  collar 

encircling  the  tooth,  to  which  sections  of  metal  tubing  or 

p       „^  lugs    are    attached   for 

,^==,_^  the    accommodation    of 

the     spring     wire,     as 

shown  in  Fig.  62. 

Some  of  the  numer- 
ous ways  in  which 
these  combination  ap- 
pliances may  be  adaj^t- 
ed  to  the  correction  of 
many  forms  of  irregu- 
larity are  shown  in 
connection  with  the 
practical  treatment  of 
cases  in  Part  III. 
Dr.  Jackson  claims  for  his  method  the  following  advan- 
tages : 

1.  "  The  materials  are  inexpensive  and  within  the  reach 
of  all." 

2.  "  The  crib  and  spring  construction  is  simple  and  quickly 
done." 


Wire  and  Band  Appliance.    (Jackson.) 


114  ORTHODONTIA. 

3.  "The  clinging  grip  of  the  crib  on  its  anchorage  is  suffi- 
cient to  liold  the  fixture  firmly,  yet  it  is  easily  sprung  off 
for  cleansing  or  change." 

4.  "  Changes  or  additions  are  easily  and  quickly  made." 

5.  "  The  structure  is  light,  cleanly  and  occupies  the  least 
possible  space  in  the  mouth." 

6.  "  Its  action  is  controllable  and  free  from  risk  of  over- 
action." 

7.  "  It  forms  a  perfect  retainer." 

Dr.  Jackson  has  recently  made  some  important  changes 
in  the  materials  used  in  the  construction  of  his  appliances. 
Finding  that  piano-wire  and  Tagger's  tin  readily  corroded 
in  the  fluids  of  the  mouth  and  produced  unsightly  stains 
upon  the  teeth  with  which  they  were  in  contact,  he  has 
almost  entirely  discarded  their  use.  In  their  stead  he  now 
employs  gold,  platinoid  and  German-silver,  uniting  them  by 
gold  or  silver  solder  or  by  soft  solder. 

For  partial  clasps  or  collars  he  prefers  gold-faced  platinum ; 
for  spring-wires,  platinous  gold  (clasp  metal) ;  while  for  base- 
wires  he  uses  platinoid.  He  finds  that  platinoid  wire,  when 
well  drawn,  possesses  qualities  more  like  piano-wire  than 
any  other  metal  or  alloy  and  tarnishes  very  little.  He 
sometimes,  also,  uses  platinoid  in  the  form  of  plate  for  par- 
tial clasps,  collars,  caps,  lugs,  etc.,  plating  the  appliances, 
when  desirable,  with  gold.  For  this  he  employs  the  Pohl- 
man  gilding  solution. 


PART    III 


SPECIFIC  FORMS  OF  IRREGULARITY  AND  THEIR 
TREATMENT. 

While  principles  and  methods  may  be  well  understood, 
illustrations  of  their  application  in  certain  forms  of  irregu- 
larity will  be  necessary  in  order  that  the  student  may 
properly  comprehend  their  practical  relationship. 

So  far  as  ease  or  difficulty  of  treatment  is  concerned,  cases 
of  irregularity  are  naturally  divided  into  two  general  classes  ; 
in  one,  the  cases  are  brought  to  our  notice  as  soon  as  the 
irregularity  begins  to  manifest  itself,  while  in  the  other,  the 
deformity  is  fully  established  and  confirmed  before  presenta- 
tion for  treatment.  In  the  first  case,  occurring  usually  in 
children,  we  have  the  advantages  of  easy  movement  and 
freedom  from  complications ;  while  in  the  second,  we  have 
to  contend  with  slow  and  difficult  movement  and  a  variety 
of  unfavorable  conditions. 

For  these  reasons  it  is  deemed  advisable  to  treat  of  certain 
forms  of  irregularity,  especially  those  involving  the  six 
anterior  teeth  of  each  jaw,  under  separate  heads,  according 
as  they  present  before  or  after  dentition  is  complete,  for  the 
treatment  in  one  case  will  vary  considerably  from  that 
required  in  the  other. 


115 


CHAPTER  I. 

INCISOR     TEETH     SITUATED     WITHOUT     OE    WITHIN    THE    LINE 
■     OF    THE    ARCH. 

Reference  has  already  been  made  to  the  fact  that  normally 
the  permanent  inferior  incisors  erupt  inside  of  the  line  of  the 
arch  and  posteriorly  to  the  deciduous  ones,  while  the  perma- 
nent superior  incisors  erupt  outside  of  their  deciduous  prede- 
cessors. From  the  limited  space  allotted  to  them,  there 
is  a  stronger  tendency  to  irregularity  on  the  part  of  the 
lower  incisors  than  there  is  on  the  part  of  the  more  favorably 
located  superior  ones,  although  the  latter  are  also  often 
found  in  a  crowded  condition,  sometimes  complicated  with 
torsion. 

So  long  as  the  inferior  ones  are  inside  of  the  arch,  even 
though  irregularly  arranged,  they  will  usually  need  no  atten- 
tion on  our  part  until  dentition  is  complete,  and  when  that 
time  arrives  it  will  generally  be  found  that  nature  has 
almost,  if  not  entirely,  corrected  the  condition. 

So  also,  where  some  of  the  superior  incisors  erupt  slightly 
outside  of  the  line  of  the  arch,  they  being  still  in  line  with 
spaces  between  them,  we  need  not  interfere,  for  in  most  cases 
the  force- exerted  by  the  lips  and  the  erupting  cuspids  will 
bring  them  into  normal  position  and  relationship. 

It  not  unfrequently  happens,  however,  that  from  some 
cause  a  superior  incisor  is  deflected  in  its  eruption  and 
appears  inside  of  the  arch,  or  that  an  inferior  incisor  is  found 
to  erupt  outside  of  the  arch.  In  either  case,  treatment  is 
indicated  as  soon  as  the  irregular  tooth  or  teeth  are  suffi- 
ciently erupted  to  enable  us  to  bring  the  proper  force  to  bear 
upon  them. 

One  of  the  earliest  methods  employed  for  releasing  an 

116 


PRACTICAL    TREATMENT.  117 

inlocked  superior  incisor  was  tliat  known  as  the  "  saddle 
and  inclined  plane,"  one  form  of  which  is  shown  in  Fig  63. 

The  saddle  was  usually  formed  of  metal,  struck  up  to  fit 
and  cover  all  of  the  lower  incisor  teeth.  ^ig  63 

To  this,  at  some  point  of  the  rida:e,  was  ,-.  .•-i;^ 

soldered  an  inclined  piece  of  heavy  metal  ^;l;,|i.,i;4ga 
so  arrranged  that  the  inlocked  tooth  would        ''  -™!'lA^^ 
strike  upon  it  in  mastication  and  be  forced       ia°i™ed  piane. 
outward  into  line. 

Later  the  appliance  was  often  made  of  vulcanite,  and 
while  in  either  form  it  generally  answered  the  purpose  of 
correcting  the  simple  irregularity,  it  was  objectionable  on 
account  of  its  size  and  because  it  was  removable  and  thus 
liable  to  be  lost  or  laid  aside  and  not  worn. 

A  modification  of  and  improvement  upon  the  old  form, 
retaining  its  virtues  and  obviatihg  its  disadvantages,  was 
devised  by  the  author  many  years  ago.  By  its  use,  when 
attached  to  a  single  tooth,  a  double  movement  is  produced, 
for  while  by  the  action  of  the  plane  the  superior  inlocked 
tooth"  is  moved  outward,  the  lower,  outstanding  one,  to 
which  the  plane  is  attached,  is  moved  inward.  When  it  is 
not  desired  to  move  the  lower  tooth  it  can  be  prevented  by 
making  the  appliance  to  include  two  or  more  teeth  and  thus 
offer  more  resistance. 

It  is  constructed  as  follows :  A  band  of  thin  platinum, 
gold  or  German  silver  plate  (No.  29,  B.  and  S.  gauge)  is  bent 
to  encircle  and  fit  the  protruding  lower  incisor,  and  the  ends 
soldered.  A  piece  of  ordinary  gold  plate  is  then  bent  double 
to  form  an  inclined  plane,  and  spread  apart  at  its  ends  to 
grasp  the  band  on  the  lingual  and  labial  surfaces,  to  which 
it  is  soldered.  It  is  next  placed  upon  the  tooth  to  see  that 
the  adjustment  is  correct,  removed,  lined  with  phosphate  of 
zinc,  and  pressed  permanently  into  position.  If  the  teeth 
are  in  close  contact  it  is  well  to  allow  the  fixture  to  be  worn 
a  day  previous  to  cementing,  for  then  the  teeth  will  have 
been  pressed  apart  and  the  replacement  with  cement  will  be 


118  ORTHODONTIA. 

more  easily  accomplished.  The  cement  not  only  lines  the 
band,  but  fills  all  the  space  between  the  inclined  plane  and 
Fig.  64.  the  tooth,  thus  giving  greater  resistance  and 
strength  in  biting.  It  is  shown  in  position  and 
separately,  in  Fig.  64.  Its  advantages  are  its 
small  size  and  absolute  fixedness.  When  the 
correction  has  been  accomplished,  it  will  be 
necessary  to  cut  the  band  in  order  to  remove  it. 
Fixed  pia^  Two  objcctious  havc  been  urged  against  the 
employment  of  inclined  planes  in  any  form  :  one,  that  by 
thus  opening  the  bite,  the  posterior  teeth  will  elongate ;  the 
other,  that  the  patient  may  avoid  biting  upon  the  plane  and 
thus  defeat  our  object.  These  objections  have  no  real  valid- 
ity, as  is  shown  by  actual  experience. 

The  short  time  that  the  bite  is  open,  usually  only  a  week 
or  two,  is  not  long  enough  to  permit  of  any  perceptible 
elongation,  while  the  patient  must  and  does  bite  upon  the 
plane  in  mastication,  because  it  is  the  only  point  where 
occlusion  is  possible. 

Another  plan  of  accomiDlishing  the  same  end  has  been 
suggested  by  Prof.  C.  N.  Peirce.  He  attaches  ligatures  to 
several  or  all  of  the  lower  incisors,  and  makes  these  fast  to 
the  molars  on  either  side.  The  ligatures  being  attached  and 
drawn  tight  while  dry,  will,  under  moisture,  contract  and 
draw  the  incisors  inward.  This  operation  is  continued  until 
the  lower  incisors  reach  a  position  inside  or  back  of  the  mal- 
posed  superior  ones.  The  ligatures  are  then  removed,  and 
the  lower  teeth,  in  gradually  resuming  the  position  they 
formerly  occupied,  will  carry  the  inlocked  superior  ones  with 
them. 

A  simple  way  of  moving  inlocked  laterals  outward  is  to 
solder  one  end  of  a  platinous  gold  bar  to  a  platinum  band 
made  to  encircle  one  of  the  laterals  and  attached  to  it  by 
zinc  cement.  Arranged  in  this  way,  the  bar  has  but  one  free 
end,  which  is  more  readily  ligated  to  the  other  lateral. 
Fig.  65  illustrates  an  appliance  of  this  character,  which 


PRACTICAL    TREATMENT. 


119 


Fig.  65. 


was  used  to  bring  out  into  i position  two  superior  laterals  in 
the  mouth  of  a  girl  ten  years  of  age.  The  case  was  compli- 
cated by  one  of  the  centrals 
being  slightly  turned  upon 
its  axis. 

A  platinum  band  or  collar 
was  made  to  fit  the  right 
lateral,  and  to  its  labial  sur- 
face was  soldered  one  end  of 
a  bar  of  spring  gold,  long- 
enough  to  extend  over  the 
centrals  and  cover  the  oppo-  spring  Bar. 

site  lateral.  The  bar  was  converted  into  a  hook  at  its  free  end 
and  so  shaped  that  in  its  course  it  touched  only  the  promi- 
nent edge  of  the  twisted  central.  The  band  was  then 
cemented  to  the  right  lateral,  and  a  section  of  small  rubber 
tubing  passed  under  the  left  lateral  and  caught  in  the  hook. 
The  appliance  thus  operated  in  two  ways  :  First,  to  bring  the 
laterals  out  into  line ;  and  next,  to  press  backward  and 
inward  the  protruding  corner  of  the  central. 

In  other  cases,  where  the  centrals  are  in  proper  position 
and  the  laterals  are  inside  of  the  arch,  the  former  may 
be  made  to  offer  the  resistance  necessary  for  bringing  the 
latter  into  alignment.  Fig.  66. 

Masfill  bands  are    fitted   to   the 
centrals,  and  a  bar  of  ^  half-round        ''  ^'1^, 

platinous  gold  is  soldered  to  these 
on  their  labial  surfaces  extending     \^ 
a  little  beyond  the  region  of  the 

laterals.  When  the  appliance  is  cemented  to  the  centrals 
each  lateral  is  ligated  to  the  bar,  which  by  its  elasticity  will 
cause  these  teeth  to  move  outward. 

Fig.  66  represents  the  device  in  position. 

Where  the  laterals  are  situated  outside  of  the  arch  line  a 
similar  appliance  is  made  with  the  extensions  of  the  bar 
resting  upon  the  laterals,  as  shown  in  Fig.  67. 


120 


ORTHODONTIA. 


Fig.  67. 


Pieces  of  elastic  rubber  inserted  between  the  bar  and  the 
laterals  will  gradually  force  them  into  position. 

If,  in  the  act  of  moving  the  laterals  inward  the  centrals 
should  be  moved  slightly  outward,  the  latter  will  usually 

fall  back  into  their  former  posi- 
tions at  the  close  of  the  operation. 
Frequently  a  better  curve  of 
^^  ~\       the  arch  is  produced  by  moving 

M^      III     ,       (  .vi\«^^     ^^^^  centrals    outward  and  the 

laterals  inward. 
For  retaining   the  moved  teeth    in  their  new   positions 
nothing  is  more  effective  and  simple  than  a  retainer  con- 
structed on   the    "  band  and  bar "  principle,  as   shown   in 
Fig.  29. 

Another  way  of  securing  the  same  result  is  by  the  use  of  a 
Coffin  plate  and  suitably-shaped  extension  wires,  as  shown 
in  Fig.  68. 

The  rubber  plate  is  made  to  cover  the  arch  and  enclose 
several  bicuspids  or  molars  on  each  side.     In  each  of  the 

buccal  portions  of  the  plate 
a  piece  of  piano-wire  is 
imbedded,  which  extends 
forward  clear  of  the  teeth 
and  terminates  in  a  curve 
or  hook  opposite  the  tooth 
to  be  moved  outward.  A 
section  of  rubber  tubing 
is  slipped  over  the  tooth 
and  caught  upon  the  hook. 
The  elasticity  of  the  rub- 
ber added  to  the  spring 
of  the  metal  will ,  rapidly  draw  the  tooth  outward  provided 
there  is  sufficient  space  in  the  arch  to  accommodate  it. 

As  already  stated,  slight  spaces  existing  between  the 
superior  incisors  when  recently  erupted  need  give  us  no 
concern  provided  they  are  in  the  normal  line  of  the  arch  ; 


MALERUPTION    OP    INCISORS. 


121 


Torsion  with  Space. 

Fig.  70. 


Torsion  with  0\ei  lapping. 


but  it  often  happens  that  in  addition  to  the  spacing  one  or 
more  of  them  is,  to  a  greater  or  less  extent,  turned  upon  its 
axis,  as  shown  in  Fig.  69. 

In  other  cases  the  teeth  may  be  in  contact,  while  one  of 
them  is  turned  and  overlapping  its  neighbor,  as  shown  in. 
Fig.  70.  In  either  case  it  is  quite 
probable  that  the  cutting  edge  of 
the  turned  tooth  will  occlude  with 
the  corresponding  surface  of  the 
one  in  the  opposite  jaw  at  an  angle, 
and  thus  either  prevent  full  eruption 
of  one  or  the  other  of  the  teeth,  or 
temporarily  open  the  bite  and  favor 
undue  elongation  of  posterior  teeth. 

Both  of  these  forms  of  irregularity 
should  receive  immediate  attention, 
for  at  an  early  age  correction  is  easily  accomplished. 
Were  the  condition  to  remain  unchanged,  it  would  neces- 
sarily become  more  complicated  from  partial  closure  of  the 
space  caused  by  the  lateral  pressure  that  would  be  exerted 
during  the  eruption  of  neighboring  teeth. 

Rotation   of  these   teeth,   as   well  as  of  others,  may  be 
accomplished    by 
one   of  the  many 
methods  described  ^^^ 

in  Chapter  V. 

Dr.  Matteson 
accomplishes  the 
same  result  with- 
out the  employ- 
ment of  a  rubber 
plate.  He  prefers 
to   band   the   first 

deciduous  and  first  '^^^s-  ^^^^  ^^'^  spring  Appliance.    (Matteson.) 

j)ermaneiit  molars  and  joining  these  bands  by  a  connecting 
strip  on  the  buccal  surface  and  a  piece  of  round  tubing 


122 


ORTHODONTIA. 


closed  at  one  end  on  the  palatal  surface,  as  shown  in  Fig.  71. 
The  incisor  to  be  moved  forward  has  a  band  of  gold  or 
platinum  cemented  to  it,  and  to  this  band,  on  the  palatal 
surface,  is  soldered  a  U-shaped  lug. 

By  inserting  a  piece  of  fine  piano-wire  into  the  tube  and 
Pi(.    72.  springing  its  free  end 

into  the  lug  on  the 
incisor  band  the 
tooth  is  readily 
forced  into  position. 

Instead  of  the  tube 
and  wire  he  some- 
times employs  a  thin 
strip     of     platinous 

Simple  Spring.    (Matteson.)  gold    SOldcred    tO  the 

bands  and  made  to  rest  and  press  against  the  in-lying  tooth, 
as  shown  in  Fig.  72. 

The  single  a|)pliance  may  be  used  to  press  forward  both 
of  the  incisors  by  arranging  the  strip  of  spring  gold  to  press 
upon  but  one  tooth  until  it  is  in  place,  and  then  altering  its 
form  by  bending  so  that  it  will  exert  its  force  upon  the 
other. 

Other  appliances  of  somewhat  similar  character  will 
readily  suggest  themselves  to  an  inventive  mind. 


CHAPTER  II. 


INCISOR    TEETH    SITUATED    OUTSIDE    OR    INSIDE    OP    THE    LINE 
OP     THE    ARCH    APTER    DENTITION    IS    COMPLETE. 

Irregularities  of  this  character  will  require  much  the  same 
treatment  as  similar  cases  occurring  during  dentition,  but  the 
attendant  difficulties  will  be  greater,  owing  to  the  increased 
density  of  the  alveolar  structure  and  the  presence  of  all  the 
teeth,  making  the  obtaining  of  space  more  difficult.  In  the 
lower  jaw,  the  irregularity  in 
most  cases  is  confined  to  one 
or  two  teeth,  standing  either 
anteriorly  or  posteriorly  to 
the  line  of  the  arch.  If 
they  are  located  posteriorly, 
and  the  extraction  of  one  of 
them  be  not  indicated,  room 
should  be  made  (if  it  does 
not  exist)  by  pressing  aj^art 
the  neighboring  teeth.  After 
this  is  done,  they  may  conveniently  be  forced  into  place  by 
means  of  a  Coffin  plate,  constructed  as  shown  in  Fig.  73. 

When  a  single  lower  incisor  is  locked  inside  of  the  arch 
by  the  overlapping  of  its  neighbors,  it  is  often  so  firmly  held 
in  its  mal-position  that  all  ordinary  means  will  fail  to  move 
it  unless  space  is  first  provided  for  it  by  lateral  pressure. 
This  being  sometimes  difficult  of  accomplishment,  the  direct 
power  of  the  screw-jack  may  be  taken  advantage  of  in  such 
cases  to  overcome  the  difficulty,  as  shown  in  Fig.  74. 

A  platinum  band  was  constructed  to  fit  the  lateral,  and  on 
its  lingual  surface  was  soldered  a  tongue  of  heavy  plati- 
num, so  formed  that  it  would  lie  in  contact  with  the  tooth 

123 


Coffin  Plate  for  Lower  Incisors. 


124 


ORTHODONTIA. 


Fig.  74. 


when  the  band  was  in  position.  Into  this  tongue,  near  its 
free  end,  was  drilled  a  countersunk  hole  nearly  deep  enough 
to  pass  through  the  metal.  On  the  opposite  side  of  the 
mouth  the  second  bicuspid  was  similarly  fitted  with  a  band, 
to  which  was  soldered  a  strip  of  platinous  gold  long  enough 
to  cover  the  lingual  surface  of  the  adjoining  molar.  By 
this  means  the  molar  was  made  to  assist  in  resisting  the 
force  to  be  applied  to  the  lateral.  The  bicuspid  band  was 
also  reenforced  by  an  additional  piece  of  heavy  platinum 

soldered  to  it  at  a  point  diag- 
onally opposite  to  the  lateral. 
Into  this  latter  piece  a  hori- 
zontal slot  was  drilled  with 
an  engine-bur,  sufficiently 
deep  and  long  to  receive  the 
fish-tail  end  of  an  ordinary 
nickeled-steel  sere  w-j  a  c  k. 
After  both  bands  were  ce- 
mented in  place  the  screw- 
jack  was  placed  between 
them,  with  the  flat  end  in 
the  bicuspid  band  and  the 
point  resting  in  the  countersunk  hole  of  the  lateral  band. 
The  patient  increased  the  tension  of  the  screw  from  day  to 
day  by  turning,  and  in  two  weeks'  time  the  tooth  was  in 
line.  It  was  held  there  until  it  became  firm  by  means  of 
platinum  binding  wire  woven  about  it  and  its  neighbors. 

In  cases  where  it  is  not  deemed  advisable  to  pursue  the 
plan  just  mentioned,  an  excellent  way  of  creating  space  and 
at  the  same  time  moving  an  incisor  outward  into  line  is  by 
the  employment  of  a  double-acting  device,  composed  of  a 
thin  metallic  ribbon  and  spring,  or  bolt  and  nut. 

The  first  recorded  suggestion  of  an  appliance  of  this  char- 
acter appears  in  one  of  Dr.  Farrar's  articles,  published  in 
1884.* 


Screu  Jack  Forcing  Out  Inferior  LateraJ 


Dental  Cosmos,  Vol.  XXVI.,  p.  672. 


MALPOSED    INCISORS. 


125 


Device  for  Lateral 


Prof.  Angle  emplo3^s  a  modified  and  simplified  device,  as 
is  shown  in  the  accompanying  illustration.  It  is  con- 
structed as  follows :  The  ribbon  being  of  sufficient  length  to 
pass  back  of  the  inlocked  tooth  and  rest  slightly  upon  the 
labial  surfaces  of  the  adjoining  teeth,  two  short  tubes  are 
soldered  to  it,  one  at  each  end.  One  of  these  tubes  is  set 
vertically  and  the  other  horizontally.  A  piece  of  steel  wire, 
bent  at  a  right  angle  at  one  end  and  thread- 
cut  and  provided  with  a  nut  at  the  other,  is 
made  to  engage  with  the  tubes,  the  bent  end 
slipping  into  the  vertical  tube  and  the  other 
passing  into  the  horizontal  one,  with  the  nut 
resting  against  its  inner  end.  By  unscrew- 
ing the  nut,  the  ends  of  the  ribbon  are  forced 
apart  and  the  desired  movements  accom- 
plished. Fig.  75  represents  the  appliance  in 
position,  and  Fig.  76  the  separate  parts  of  Movement.  (Angle.) 
which  it  is  constructed.  In  this  device  the  direct  power  of 
the  screw  is  used  to  furnish  the  necessary  pressure. 

Instead  of  the  nut  and  bolt.  Prof.  Matteson  prefers  a  coiled- 
wire  spring  to  operate  upon  the  ends  of  the  ribbon,  as 
shown  in  Fig.  77. 

The   spring   is  made  Fig 

from  piano-wire.  No.  14 
or  16,  and  when  in 
place  the  ends  rest  in 
two  short  tubes  soldered 
horizontally  to  the  rib- 
bon near  its  extremities. 
The  tubes  have  slots 
cut  into  their  upper  sur- 
faces    to      prevent     the  Lateral  Movement.    (Matteson) 

spring  from  pressing  upon  the  gum. 

Should  the  tension  of  the  spring  not  be  sufficient  to  move 
the  tooth  entirely  into  place,  a  longer  one  may  be  substituted 
for  it. 


126 


ORTHODONTIA. 


Fig.  78. 


As  will  be  noticed,  the  ribbon  has  a  short-headed  pin  or 
post  soldered  to  its  exposed  surface  opposite  the  centre  of  the 
inlocked  tooth  to  furnish  a  ready  means  of  ligating  the  band 
to  the  tooth  should  it  be  necessary  to  prevent  its  slipping  out 
of  position. 

Another  appliance  for  drawing  outward  an  instanding 
incisor  is  known  as  Siegfried's  Regulating  Spring.*  It  is 
shown  in  position  in  Fig.  78  and  separate  in  Fig.  79. 

The  spring  is  fashioned  from 
hard-drawn  German  silver, 
platinous  gold  or  piano-wire. 
It  consists  of  a  central  coil 
with  a  wing  extending  on  each 
side.  When  in  repose  these  two 
wings  lie  against  one  another. 
The  tooth  to  be  removed  is 
fitted  with  a  Magill  band,  to 
the  buccal  side  of  which  is 
soldered  a  stiff'  wire  bent  in 
the  form  of  a  U  with  one  arm 
slightly  longer  than  the  other. 
After  the  band  is  cemented 
to  the  tooth  the  wings  of  the 
spring  are  opened,  the  coil 
slipped  over  the  U  wire  with 
the  wings  pressing  upon  the 
adjoining  teeth.  To  prevent , 
the  spring  from  slipping  off  the  longer  arm  of  the  U  wire 
is  bent  over  after  the  spring  is  in  position.  The  constant 
tension  of  the  spring  will  tend  to  move  the  tooth  outward  into 
line,  the  arrows  in  Fig.  78  showing  the  direction  of  the  forces. 
When  an  incisor  tooth  in  the  lower  jaw  stands  outside  of 
the  arch,  the  malposition  is  usually  due  either  to  its  having 
been  forced  out  of  place  by  a  superior  one  occluding  back 
of  it,  or  to  unusual  crowding  on  the  part  of  its  neighbors. 
In  the  first  instance,  the  correction  of  the  occlusion  of  the 

*  Dental  Cosmos,  June,   '96,  p. 


Siegfried  Spring. 


Fig.  79. 


Detail  of  Construction. 


MALPOSED    INCISORS.  127 

superior  tooth  will  usually  press  the  lower  one  into  its 
proper  place,  while  in  the  second  instance,  it  will  be  neces- 
sary to  consider  the  advisability  of  extracting  one  of  the 
crowded  teeth  to  afford  room.  If  such  extraction  be  deemed 
best  the  case  will  be  greatly  simplified  and  the  malposed 
tooth  can  be  brought  into  line  by  some  one  of  the  means 
described  for  drawing  inward  the  suj)erior  incisors. 

If  it  be  deemed  inexpedient  to  extract  one  of  the  crowded 
teeth,  room  will  have  to  be  provided  either  by  expanding 
the  arch  or  by  extracting  a  tooth  or  teeth  back  of  the  cuspids. 

In  considering  the  matter  of  expansion  of  the  arch  it 
should  be  borne  in  mind  that  the  enlargement  of  one  arch 
may  also  necessitate  the  expansion  of  the  other  in  order  to 
preserve  the  normal  occlusion.  If  both  jaws  will  admit  of 
it  to  advantage,  it  may  be  the  best  plan  to  pursue,  although 
it  will  necessarily  increase  the  labor  and  difficulty  of  the 
operation.  Generally,  if  the  occlusion  and  facial  expression 
be  satisfactory,  it  will  be  far  better  not  to  disturb  the  general 
relation  of  the  teeth,  but  rather  to  extract  one  or  more  of 
the  bicuspids  or  molars.  After  any  of  the  posterior  teeth 
have  been  extracted,  the  anterior  ones  can  be  moved  apart 
or  backward  and  the  irregular  tooth  brought  into  place. 

The  inferior  incisors,  after  being  brought  into  line,  will 
usually  be  retained  in  place  by  the  occlusion  of  the  superior 
teeth,  but  where  this  is  not  the  case,  they  may  be  retained 
by  means  of  platinum  binding  wire  woven  about  all  of  the 
incisors  at  or  near  their  necks,  or  they  may  be  securely  held 
by  means  of  a  ribbon  of  thin  gold  fitting  the  lingual  sur- 
faces of  the  incisors,  to  which  is  soldered  a  platinum  band 
to  encircle  each  tooth  that  has  been  corrected.  The  piece  is 
set  with  phosphate  of  zinc  as  a  lining  to  the  bands. 

For  drawing  or  forcing  into  line  any  of  the  superior 
incisors  standing  outside  of  the  arch,  a  variety  of  methods  is 
at  our  disposal.  In  the  upper  jaw  the  extraction  of  one  or 
more  incisors  to  provide  room  for  other  outstanding  ones  is, 
except  in  rare  cases,  not  to  be  thought  of,  although,  as  just 
stated,  in  the  lower  jaw  extraction  may  often  be  advantage- 


128 


ORTHODONTIA. 


ously  resorted  to.  The  greater  conspicuousness  of  the  su- 
perior incisors,  and  the  difference  in  size  between  the  centrals 
and  laterals  would  cause  the  absence  of  any  one  of  them  to 
be  most  noticeable.  Rare  cases  occur,  however,  in  which 
such  extraction  is  justifiable,  as  already  described,  but  a 
wise  discrimination  must  be  exercised  in  regard  to  the  mat- 
ter, as  otherwise  a  greater  deformity  is  likely  to  be  created 
than  the  one  already  existing.  Where  space  is  needed  in 
the  arch  for  the  outstanding  tooth  or  teeth  and  expansion  of 
the  arch  is  not  indicated,  we  may  obtain  it  by  extraction 
back  of  the  cuspids,  or  where  the  lack  of  space  is  slight  in 
amount  it  may  be  secured  by  simply  exerting  pressure 
upon  the  adjoining  anterior  teeth.  A  simple  way  of  produc- 
ing this  pressure  is  by  the  use  of  compressed  wood,  as 
described  on  page  82. 

Another  plan  is  by  means  of  a  vulcanite  plate  to  which 
are  attached  gold  or  steel  wires  so  arranged  that  their  free 
ends  when  drawn  together  and  inserted  in  the  space  intended 
to  be  widened,  will  press  the  adjoining  teeth  farther  apart. 
Still  another,  without  the  use  of  a  plate,  which  the  author 
has  found  very  effective,  consisting  of  platinum  bands  at- 
tached to  the  teeth  to  be  moved,  with  a  piano-wire  spring 
acting  between  them,  is  described  and  illustrated  in  Part 
III.,  chapter  VI. 

Dr.  Farrar  recommends  for  the  same  purpose  a  delicate 
screw-jack  with  crutch  ends  to  fit  the  teeth  to  be  separated. 
Prof.-Goddard  employs  for  the  same  purpose  an  appliance, 
as  shown  in  Fig.  80,  and  constructed  as  follows : — 

The  two  teeth  bordering 
the  space  are  encircled  by 
bands  having  short  open 
tubes  soldered  to  their  labial 
surfaces- in  a  horizontal  posi- 
tion. Through  these  tubes 
is  passed  a  threaded  wire 
having  two  nuts  uj^on  it. 
One  of  these  is  designed  to 


Appliance  for  Separation.    (Goddard.; 


MALPOSED    IXCISOES. 


129 


simply  offer  resistance,  while  the  other,  by  being  turned, 
will  gradually  force  the  teeth  apart. 

After  the  desired  space  has  been  obtained,  the  inlocked 
tooth  may  be  brought  into  place  by  any  method  preferred. 

Prof.  Goddard  has  recently  improved  his  screw  and 
band  appliance  by  looping  a  rubber  ring  over  the  screw 
and  passing   it   over  Fig  81. 

the  lateral,  as  shown 
in  Fig.  SI.  By  this 
simple  arrangement 
the  lateral  is  moved 
outward  at  the  same 
time  that  the  central 
and  cuspid  are  being- 
forced  apart. 

In  devising  appli- 
ances for  moving  the 
superior  incisor  teeth 

either  inward   or  out-         combined  separation  and  Traction.     (Goddard.) 

ward  into  line,  due  consideration  must  be  given  to  the 
occlusion.  To  avoid  conspicuousness,  it  is  desirable  to  have 
the  operating  appliances  placed  within  the  arch,  but  very 
frecjuently  the  occlusion  of  the  lower  teeth  will  interfere 
with  such  arrangement.  In  the  latter  case  they  may  be  so 
constructed  as  to  operate  from  the  outside. 

Fig.  82  shows  a  com- 
mon form  of  band  and 
bow-spring  arrange- 
ment in  which  the  in- 
standing  incisors  are 
operated  upon  by  rub- 
ber bands  looped  over 
the  bow-spring.  When 
the  teeth  approach 
the    wire    the    arch   is 

enlarged  by   means   of  Adiu.tahie  i  ..>v  ^pim..  .(.add^iu) 

the  nuts  operating  against  the  tubes  on  the  bands. 


Fig.  92. 


130 


ORTHODONTIA. 


One  of  the  simplest  methods  for  movmg  one  or  more  in-' 
cisors  outM^arcl  into  hne  is  b}^  the  employment  of  the  Coffin 
solid  plate,  as  shown  in  Fig.  53.  The  only  difficulty  met 
with  by  the  author  in  the  use  of  this  form  of  plate  has  been 
where  the  teeth  to  be  moved,  although  inside  of  the  arch, 
stand  perj^endicularly  or  incline  slightly  forward.  In  these 
cases  the  free  ends  of  the  wires,  after  being  pressed  up  into 
position  on  the  teeth,  are  frequently  thrown  down  toward 
the  cutting  edge  by  the  force  of  the  spring  operating  upon 
an  inclined  surface.  When  great  inconvenience  arises 
from  this  cause,  it  may  be  remedied  b}^  cementing  a  nar- 
row platinum  band  about  midway  of  the  crown  of  the  tooth 
to  be  moved,  and  placing  the  end  of  the  wire  spring  above  it. 
Another  plan  for  moving  outward  any  or  all  of  the  supe- 
rior incisors,  is  by  means  of  a  plate  constructed  as  shown  in 
Fig.  83. 

A   thin    vulcanite   plate   is   made   to   cover   the   roof  of 
Fig.  83.  the  mouth   and  cap 

the  bicuspids  a  n  d 
molars ;  opposite  the 
tooth  or  teeth  to  be 
moved  the  plate  is  al- 
lowed to  come  nearly 
down  to  their  cutting 
edges.  Directly  oppo- 
site the  center  of 
each  of  these  teeth  a 
hole  is  drilled  entirely 

Vulcanite  Plate  with  Screw*.  tlirOUgh     the     rubber 

to  receive  a  piece  of  screw  wire  long  enough  to  pass  through 
and  project  a  httle  beyond  the  plate.  In  springing  the 
plate  into  position  the  slightly  projecting  ends  of  the 
screws  will  press  against  the  teeth  and  they  will  be  moved 
forward.  A  half  turn  of  the  screws  every  day  will  soon  force 
the  teeth  into  position. 

Dr.  Dodge*  suggests  the  employment  of  a  hollow  metal 

'^Dental  Cosmos,  Vol.   XXXI.,  p.  772. 


MALPOSED    INCISORS. 


131 


screw  tipped  with  gutta-percha  at  its  exposed  end  used  in 
connection  with  a  vulcanite  plate,  as  just  described,  claiming 
for  it  greater  friction  in  contact  with  the  tooth  and  non- 
liability to  injury  of  tooth  substance. 

Less     cumber-  fig.  84. 

some  than  rubber 
plates  and  more 
positive  and  satis- 
factory in  the 
majority  of  cases 
are  appliances  con- 
structed entirely  of 
metal. 

Fig.  84  shows 
one  of  this  charac- 
ter designed  by 
Prof.      Matteson,* 

somewhat     on    the  Moving  Ceutrals  Outward.     (Matteson.) 

Angle  plan,  for  the  purpose  of  moving  forward  two  inlocked 
superior  central  incisors.  As  will  be  seen,  it  is  firml}^ 
attached  to  the 
anchor  teeth  by  ce- 
mented bands  and  is 
operated  by  turning 
the  nuts  which  rest 
against  tubes  soldered 
to  the  anchor  bands. 
Should  the  occlu- 
sion not  permit  the 
use  of  the  appliance 
just  described,  the 
same  end  may  be 
attained  by  employ- 
ing a  fixture  devised 
by  Dr.  Kirkf  and  illustrated  in  Fig.  85. 

*  Dental  Review,  July,   '92,  p.  564. 

■\ Dental  Cosmos,  Vol.  XXXIII.,  p.  908. 


Fig.  85. 


Plate,  Band  and  Bar  Appliance.    (Kirk.) 


132 


ORTHODONTIA. 


It  consists  of  a  narrow  silver  plate  swaged  to  fit  and  partly , 
cover  the  roof  of  the  mouth,  to  which  are  attached  two  broad 
clasps  of  platinized  gold  fitting  the  first  molars.  To  the 
buccal  surfaces  of  these  clasps  are  soldered  tubes  closed  at 
their  distal  ends  to  receive  a  gilded  piano-wire,  bent  to  con- 
form to  the  outline  of  the  arch,  but  slightly  longer. 

When  in  position,  the  inlocked  centrals  are  tightly  ligated 
to  the  wire  immediately  in  front  of  them,  which  by  its  elas- 
ticity draws  them  forward. 

An    appliance    differing    somewhat    from   the   one    just 

described  is  that  of  Dr.  Bedell,*  shown  in  Fig.  86.     In  this 

case  the  bow-spring  is  made  of  flattened  German  silver  wire, 

Fig.  86.  which,     after 

being  bent  in- 
to the  form  of 
an  ideal  arch 
has  its  ends 
soldered  to 
bands  that 
encircle  the 
first  molars. 
The  bands 
that  are  fit- 
ted to  the 
teeth  to  be 
moved  have 
dt  Bedell's.  Appliance  a    threaded 

wire  attached  to  the  center  of  their  labial  surfaces.  These 
wires  or  screws  pass  through  holes  drilled  in  the  bow-wire 
after  which  nuts  are  run  down  upon  them.  Turning  the 
nuts  bends  the  bow-wire  inward  and  it  in  turn  by  its  elas- 
ticity tends  to  dra^v  the  teeth  outward.  As  the  teeth  move 
the  projecting  wires  are  ground  off  close  to  the  nuts  to 
prevent  irritating  the  lip. 


^liems  of  Infercf^t,  Aug.,   '97,  p.  599. 


MALPOSED    INCISORS. 


Fig.  87. 


Another  apj^liance,  simple  in  construction  and  not  inter- 
fering with  occlusion,  designed  to  draw  one  central  outward 
into  line  and  at  the  same  time  press  the  adjoining  promi- 
nent one  back  into  place,  is  shown  in  Fig.  87. 

It  was  devised  by  Dr.  Jackson  and  is  constructed  after  his 
method.  The  first 
molar  is  fitted  with  a 
crib  to  which  the  ex- 
tending spring-wire  is 
attached.  This  engages 
at  its  free  end  with  a 
tubed  band  cemented  to 
the  inlying  central,  and 
in  its  course  rests  upon 
and  presses  against  the 
prominent  central.  A 
double     movement     is  '4„ 

thus  produced  and  the        ^"^'  ^^"^^  ^""^  ^^™s  ^e^i°<^-  (Jackson.) 
power  of  the  spring  may  be  increased  as  desired  by  straight- 
ening its  curve. 

Still  another  device,  even  more  simple  than  the  preceding 

Fig.  88. 


one,  for  moving  for- 
ward an  inlocked 
incisor,  is  illustrated 
in  Fig.  88. 

It  also  is  one  of  Dr. 
Jackson's,-  and  con- 
sists    simnlv     of     a  Tuted-Band  and  Spring.    (Jackson.) 

tubed-band  attached  to  the  malposed  tooth  and  an  ingeni- 
ously arranged  wire  spring  to  furnish  the  motive  power. 
The  spring  is  formed  by  bending  a  piece  of  piano-wire 


134 


ORTHODONTIA. 


into  the  form  of  a  loop  with  one  end  much  longer  than  the 
other  and  both  of  them  suitably  curved  to  follow  the  out- 
line of  the  arch.  The  longer  arm  of  the  spring  should  at 
least  be  long  enough  to  cover  the  surfaces  of  three  teeth  to 
furnish  proper  support. 

In  adjusting  the  spring,  the  longer  arm  should  be  next 
to  the  gum  while  the  shorter  one  is  being  inserted  into  the . 
tube,  then  by  turning  it  downward   the   whole  appliance 
comes  into  proper  j)Osition  with  the  shorter  arm  acting  as  a 
spring  to  draw  the  incisor  outward. 

When  the  tooth  is  in  place  it  may  be  retained  by  insert- 
ing a  short  wire  into  the  tube  and  allowing  it  to  rest  upon 
the  labial  surfaces  of  the  two  adjacent  teeth. 

Where  any  one  or  two  of  the  superior  incisors  stand  out- 
side and  there  is  a  space 
for  their  accommoda- 
tion in  the  arch  they 
can  very  easily  be 
moved  into  place  by 
means  of  a  plate  as 
shown  in  Fig.  89. 

The  plate  is  of  vul- 
canite in  which  two 
piano-wire  sjDrings  are 
imbedded.  These 
spings  are  arranged  to 
rest  and  bear  upon  the  outstanding  teeth  and  may  be  bent 
from  time  to  time  to  increase  the  tension. 


Vulcanite  Plate  with  Piano-Wire  Springs. 


CHAPTER  III. 


CUSPID    TEETH    SITUATED    OUTSIDE    OR    INSIDE    OF    THE    AECH. 


Delayed  or  Malerwption  of  Cuspids. 


The  third  molars  excepted,  the  superior  cupids  are  usually 
the  last  teeth  of  the  permanent  set  to  erupt,  and  they  almost 
invariably  make  their  appearance  outside  of  the  arch.  When 
there  is  room  in  the  arch  for  their  accommodation  and  they 
erupt  directly  outside  of  it,  we  may  feel  assured  that  in  due 
time  they  will  find  their  way  into  place  unaided.  Where, 
however,  they  erupt  over  the  lateral  incisors,  as  is  sometimes 
the  case,  and  these  incisors  are  in  consequence  being  forced 
inward,  it  becomes  necessary  for  us  to  interfere  and  endeavor 
to  draw  the  cuspids  toward  their  proper  places.  This  is 
usually  not  a  difficult  matter  when  the  cuspid  crown  is  far 
enough  erupted  to  enable  us  to  exert  pressure  upon  it.  In 
such  a  case,  by  cementing  a  Magill  band  to  the  cuspid  and 
another  to  the  second  bicuspid  or  first  molar,  each  having  a 
pin  or  hook  attached  to  its  buccal  surface,  a  rubber  ring 

extending  from  hook  to 
hook  will  in  a  short  time 
draw  the  cuspid  back  to  a 
position  opposite  the  sj)ace 
it  is  to  occupy,  as  illustra- 
ted in  Fig.  90. 

It  sometimes  happens, 
however,  that  the  cuspids 
are  tardy  in  their  eruption 
and  fail  to  assume  their 
positions  in  the  arch  at  the 
time  they   are   needed  to 


Retraction  of  Cuspids     (\ntlior) 


135 


136  ORTHODONTIA. 

complete  the  row  and  prevent  the  incisors  and  bicuspids 
from  encroaching  upon  the  space  the  cuspids  are  to  occupy. 
In  such  cases  it  is  generally  advisable  to  hasten  their  erup- 
tion by  the  application  of  tractile  force  in  some  manner. 
Where  one-half  of  the  crown  is  through  the  gum  we  can 
attach  to  it  a  Magill  band  with  a  pin,  hook  or  other  pro- 
jection upon  it,  and  by  its  assistance  readily  apply  power 
to  the  tooth. 

The  author  has  had  several  cases  where  extrusion  of  the 
cuspid  was  called  for,  when  only  the  cusp  of  the  tooth  was 
visible  through  the  gum.  Here  the  application  of  a  cemented 
band  was  out  of  the  question,  and  attachment  to  the  tooth 
had  to  be  gained  in  another  way.  The  difficulty  was  solved 
by  tying  a  silk  ligature  in  a  half  knot,  passing  it  over  the 
projecting  cusp,  and  then  with  a  small,  flat  plugger,  forcing 
this  ligature  up  under  both  gum  and  alveolus  until  it  encir- 
cled the  neck  of  the  tooth,  when  it  was  drawn  tight  and 
made  fast  with  a  surgeon's  knot.  A  very  small  gold  ring, 
with  a  center  only  large  enough  to  admit  of  the  passage  of 
silk  floss,  was  then  slipped  over  one  of  the  ends  of  the  liga- 
ture and  tied  so  that  it  would  lie  upon  the  labial  face  of  the 
tooth  near  the  gum.  This  ring  was  allowed  to  remain  with- 
out change  until  the  tooth  was  drawn  into  position.  A 
delicate  vulcanite  plate  was  constructed  to  fit  the  arch,  and 
extend  into  the  space  between  the  lateral  and  first  bicusiDid. 
At  this  latter  point  the  plate  was  thickened  until  it  was 
nearly  on  a  level  with  the  occlusal  surfaces  of  the  adjoining 
teeth,  and  made  concave  on  its  most  prominent  part.  A 
rubber  spur  was  also  formed  on  the  plate,  in  a  line  with  the 
cuspid  and  space.  The  plate  being  in  position,  a  rubber 
band  was  passed  over  the  spur  and  drawn  tight  to  the  ring 
on  the  tooth  by  means  of  a  ligature,  the  band  in  its  course 
resting  in  the  notch  of  the  elevation  on  the  plate.  By  this 
arrangement  no  pain  was  inflicted  except  that  incident  to 
forcing  the  ligature  into  position  under  the  gum,  while  power 


MALERUPTION    OF     CUSPIDS. 


137 


was  exerted  in  a  nearly  direct  line  with  the  long  axis  of  the 
tooth,  and  in  a  gentle,  continuous  manner. 

Another  and  most  excellent  j)laii  of  securing  attachment 
to  a  partially  erupted  cuspid,  is  that  recommended  by  Prof. 
J.  F.  Flagg.  It  consists  in  screwing  a  gold  ring-bolt  or  screw- 
eye  into  the  point  of  the  cusp.  The  screw-eye  is  made  by 
soldering  a  small  gold  ring  to  a  piece  of  gold  screw-wire. 
After  the  correction  is  accomplished,  the  screw  is  removed 
and  the  hole  filled  with  gold. 

A  very  simple  and  effective  appliance,  securely  attached 
to  the  teeth,  for  drawing  a  cuspid  down  into  position  has 
been  devised  by  Dr.  Angle,  and  is  shown  in  Fig.  91. 

As  will  be  seen,  the  bicuspid  is  fitted  with  a  metal  band 
to  which  is  soldered  a  short 
piece  of  tubing.  A  wire 
of  suitable  length  is  flat- 
tened at  one  end  and  bent 
into  a  hook  to  engage  with 
the  cutting  edge  of  the 
lateral,  while  the  other 
end    is    bent   at   a   right 


angle  to  fit  into  the  tube 
on  the  bicuspid  band. 
Midway  of  the  length  of 


Fig.  91. 


Drawing  Down  Cuspid.    (Angle.) 


this  wire  is  soldered  a  small  button.  The  unerupted  cuspid 
has  a  headed  pin  cemented  into  its  labial  surface  or  point  of 
cusp,  and  over  this  pin  and  the  button  on  the  wire  is 
stretched  a  section  of  rubber  tubing  to  produce  the  desired 
tension. 

If  malposition  of  an  erupting  cuspid  should  be  compli- 
cated with  more  or  less  torsion,  the  correction  of  the  latter 
will  be  best  accomplished  after  the  tooth  is  nearly  or  quite 
in  position. 


138  ORTHODONTIA. 


Cuspid  Teeth  Situated  Outside  or  Inside  of  the  Arch. 

Of  the  various  forms  of  irregularity  that  present  for  treat- 
ment, none  perhaps  is  more  common  than  that  in  wliich  the 
cuspid  teeth  are  located  outside  of  the  arch.  The  cause 
most  frequently  responsible  for  this  condition  is  the  pre- 
mature extraction  of  the  temporary  cuspids,  although  it  is 
often  caused  by  delayed  eruption  of  the  permanent  ones,  and 
by  the  lack  of  accommodation  a  small  arch  sometimes  affords 
for  the  full  complement  of  teeth.  The  cuspids  (superior) 
being  among  the  later  teeth  to  appear,  often  find  their  terri- 
tory pre-occupied  by  the  earlier  arrivals.  Frequently, 
though  not  always  the  malposition  of  the  cuspids  is  associ- 
ated with  like  malposition  of  certain  neighbors,  usually  the 
central  and  lateral  incisors.  The  irregularity  of  these  adjoin- 
ing teeth  is,  in  most  cases,  brought  about  by  the  pressure  of 
the  cuspids  in  their  attempt  to  occupy  their  places ;  for  pre- 
vious to  their  appearance  there  is  no  inducement,  if  the 
occlusion  be  normal,  for  the  incisors  to  vary  much  from 
their  true  positions.  The  fact  should  not  be  overlooked  that 
all  teeth  in  erupting  are  impelled  by  a  strong  hidden  force 
to  seek  their  jDroper  positions  in  the  line  of  the  arch,  and  in 
no  teeth  is  this  persistence  more  plainly  or  powerfully  exhibi- 
ted than  in  the  cuspids. 

The  conditions  being  favorable  each  tooth  will  naturally 
assume  its  place  in  line,  and  should  obstructions  interfere 
it  will  strive  to  overcome  them ;  but  the  cuspid  teeth  will,  if 
necessary,  exert  a  power  far  exceeding  that  of  any  of  the 
other  teeth  in  their  efforts  to  gain  their  proper  positions  in 
the  arch.  To  this  end  incisors  are  often  disarranged,  and 
bicuspids  forced  inward  or  outward.  This  wonderful  force 
exerted  by  the  cuspids,  may  well  be  illustrated  by  a  case 
which  occurred  in  the  practice  of  the  author  many  years 
ago: 


IRREGULAR    CUSPIDS.  139 

The  patient  was  a  young  lady  about  fifteen  years  of  age, 
in  whose  upper  jaw  a  cuspid  had  erupted  outside  of  tlie 
arch,  causing  projection  of  the  lip.  All  of  the  other  teeth 
were  regular,  but  the  bicuspids  and  molars  on  the  affected 
side  were  somewhat  in  advance  of  their  true  positions,  and 
there  was  consequently  very  little  space  in  the  arch  for  the 
accommodation  of  this  cuspid.  The  first  molar  on  the  same 
side  was  badly  decayed,  so  it  was  decided  to  extract  it  pre- 
liminary to  making  room  for  the  cuspid.  An  aj^pliance  was 
then  attached  to  the  second  molar  and  second  bicuspid, 
intended  to  draw  the  latter  tooth  backward.  The  patient 
left  with  this  fixture  in  position  and  did  not  return  until 
eighteen  months  later,  when  it  was  noticed  that  both  bicus- 
pids had  moved  backward  and  the  cuspid  occupied  its  nor- 
mal position  in  the  arch.  It  transpired  that  the  appliance, 
having  caused  some  pain,  was  removed  by  the  patient  two 
days  after  it  had  been  placed  in  ]30sition.  The  correction  of 
the  irregularity  had  been  entirely  accomplished  by  the 
cuspid  forcing  its  way  into  place  and  crowding  the  bicuspids 
backward  in  the  eff'ort. 

To  obtain  space  for  the  accommodation  of  the  cuspid  when 
it  is  situated  outside  of  the  arch,  we  usually  have  to  decide 
between  the  enlargement  of  the  arch  and  the  extraction  of  a 
tooth  anterior  or  posterior  to  it.  If  the  upper  arch  is  con- 
tracted and  will  admit  of  expansion  to  advantage,  it  may 
be  done  by  one  of  the  methods  described  in  Chapter  VI.  of 
this  part ;  but  if  this  be  not  indicated,  we  will  have  to  decide 
upon  the  extraction  of  a  bicuspid  or  lateral  in  order  to 
obtain  space. 

A  careful  consideration  of  the  rules  governing  extraction, 
Part  I.,  Chapter  VI.,  will  greatly  assist  the  operator  in 
deciding  which  tooth  to  extract. 

It  very  frequently  happens  that  the  space  in  the  arch 
intended  to  accommodate  the  cuspid  is  nearly,  but  not  quite, 
sufficient.     In  such  cases,  slight  additional  space  may  gen- 


140 


ORTHODONTIA. 


Fig.  92. 


erally  be  gained  by  pressing  apart  the  adjoining  teeth  by  . 
one  of  the  methods  shown  in  Part  III.,  Chapter  VI. 

Room  having  been  provided,  tlie  cuspid  tooth  may  be 
brought  into  place  by  one  of  several  methods  that  are 
equally  effective  in  the  upper  and  lower  jaws.  Outstanding 
cuspids  are  usually  situated  a  little  in  advance  of  their  nor- 
mal positions,  so  that  in  bringing  them  to  place  we  must 
exert  force  in  a  backward  as  well  as  inward  direction. 

Where  from  the  appearance  of  the  teeth  and  surround- 
ing parts  it   seems  probable   that  great   force  will  not   be 

required,  a  cuspid  may  fre- 
quently be  drawn  inward 
by  so  simple  a  means  as 
that  shown  in  Fig.  92. 

In  this  case  a  platinum 
band,  with  a  pin  on  its 
labial  face,  was  cemented 
to  the  outstanding  cuspid. 
To   the  first   bicuspid   on 

Metal  Bands  and  Rubber  Ring.  ^hc  OppOsite  sidc  WaS  fitted 

a  similar  band  with  a  small  gold  hook  on  the  palatal 
surface  and  a  bar  of  platinous  gold  on  the  buccal  surface 
long  enough  to  extend  to  and  rest  upon  the  adjoining- 
cuspid  and  second  bicuspid.  This  provided  the  resistance 
of  three  teeth,  while  attachment  was  made  to  but  one., 
A  thin  vulcanite  plate  was  made  to  cover  the  arch  so  as  to 
protect;  it  from  the  irritation  of  the  rubber  ring,  which 
was  stretched  from  band  to  band.  The  operation  of  bring- 
ing the  tooth  into  line  was  somewhat  slow,  occupying  some 
four  or  five  weeks'  time,  but  the  object  was  satisfactorily 
accomplished. 

For  moving  a  single  cuspid  inward  into  line,  where  space 
exists  for  its  accommodation,  a  modified  Siegfried  spring 
may  be  employed  as  shown  in  Fig.  93. 

In  this  case  but  one  wing  of  the  spring  is  used  for  the 


IRREGULAR    CUSPIDS. 


141 


Fig.  9:?. 


X 


application  of  force,  the  other  resting  upon  a  wire  frame- 
work which  extends  to  and  lies  against 
some  posterior  tooth. 

The  banded  tooth  is  kept  from  mov- 
ing by  having  attached  to  it  a  piece 
of  stiff  metal  which  im|)inges  upon  the 
two  adjoining  teeth. 

Where  the  movement  to  be  effected 
is  more  backward  than  inward,  it  may 
often  be  very  satisfactorily  and  easily 
accomplished  by  the  simple  apjjliance 
shown  in  Fig.  94. 

A   platinum   band,  with   short  gold  i  1,  lli 

wires   soldered   to  the  buccal  and  lin-  i  J  i 

gual  surfaces,  is  cemented  to  the  tooth  / 

to  be  moved,  while  a  similar  one  is  at-         ^''^'"''^  ^^''''^• 
tached  to  a  molar  or  other  anchor  tooth.     The  wires  on  the 
anterior  band  are  bent  forward,  and  those  on  the  posterior 
one  are  curved  backward.     Two  rubl^er  rings,  caught  over 


Fig.  94. 


the  gold  hooks,  connect 
the  two  bands  and  yield 
the  tractile  power  required. 
'Jdiese  rubber  rings  can  be 
removed  and  replaced  for 
cleansing  the  teeth,  or  can 
be  renewed  at  will  by  the 
patient.  Two  rings  can 
be  attached  to  each  pair 
of  hooks,  if  greater  power 
be  rec[uired,  or  the  same 

object  can    be    attained  by  Author's  Appliance  for  Retraction. 

cutting  wider  rings  from  thicker  tubing. 

Prof  Goddarcl  has  modified  the  author's  appliance  by 
using  tubes  on  the  buccal  surfaces  of  the  molar  bands 
instead  of  hooks.     These  tubes  can  subsequently  be  used  for 


142 


ORTHODOXTIA. 


accommodating  a  bow-wire  witli  which  to  draw  out  any  of 
the  instanding  incisors.  (See  Fig.  95.) 

Another  simple  way  of  bringing  about  tlie  same  move- 
FiG.  95.  ment,    is    by    tire    use 

of  a  Coffin  j)late  with 
the  wire  or  wires  at- 
tached to  the  buccal 
portion  and  extending 
forward  until  their  free 
ends  rest  upon  the  teeth 
to  be  moved.  Ordina- 
rily, the  pressure  to  be 
exerted  by  them  would 
be  inward  only ;  but  by 
Modiflcition  bv  Prof  Goddard.  bending  their  ends  into 

the  form  of  partial  hooks,  so  as  to  engage  with  the  mesial 
surfaces  of  the  teeth,  an  additional  backward  pressure  is 
obtained.     (See  Fig.  89.) 

Fig.  96  represents  a  vulcanite  plate  with  platinous  gold 

springs  for  pressing 
backward  the  superi- 
or cuspids,  as  em- 
ployed by  Dr.  Kells."^ 
By  repeated  bending 
of  the  springs  from 
day  to  day  the  cus- 
]  )ids  may  be  rapidly 
I  aished  back  into  the 
-paces  created  by  the 
extraction  of  the  first 
bicuspids.  The  plate 
is  rather  cumbersome 

Vulcanite  Plate  and  Gold  Wire  Springs.    (Kells.)        but  it  is  a  simple  aild 

inexpensive  method  of  accomplishing  the  desired  result. 


Fig.  96. 


C^ 


e^.. 


^Itvms  of  Interest,   Jan.,    '97,   p.  50. 


IRREGULAR    CUSPIDS. 


143 


In  most  cases,  however,  greater  force  than  that  exerted  by 
a  rubber  band  or  spring  wire  will  be  necessary  to  draw  a 
cuspid  into  place,  especially  if  it  be  large  and  firmly  im- 
planted. In  such  event  the  power  exerted  by  a  screw  in 
some  form  will  probably  yield  the  best  results. 

One  of  the  simplest  and  best  appliances  for  drawing  a 
cuspid  backward  and  inward  into  line  is  that  devised  by 
Prof.  Angle  and  shown  in  Fig.  97. 

The  first  molar  is  encircled  by  a  metal  band,  to  which 
on  its  palatal  surface  is  sol- 
dered a  long  piece  of  tubing 
to  accommodate  the  traction 
screw. 

The  cuspid  is  also  encir- 
cled by  a  band  with  a  short 
tube  soldered  horizontally  to 
it  on  its  distal  surface  with 
which  the  bent  end  of  the 
traction  screw  engages. 

The  nut  operating  against       _^ 
the   distal   end   of  the  long  Retraction  of  cuspid. 

tube  will  rapidly  move  the  cuspid  into  position. 

Fig.  98  illustrates  an- 
other appliance  of  Prof. 
Angle's,  very  similar  in 
character,  but  with  the 
tube  and  screw  located 
upon  the  outside  of  the 
arch. 

It  will  be  noticed  that 
on  the  left  side  the  short    ^ 
pipe  or  tube  is  attached  ff 
to  the  cuspid  band   at 
the  mesio-buccal  angle 
of  the  tooth  in  order  to 

rotate  it  as  well  as  draw        Backward  Movement  and  Rotation.  (Angle.) 

it  backward,  while  upon  the  right  side  the  screw  is  hooked 


(Angle.) 


Fig.  98. 


\ 


144 


ORTHODONTIA. 


Fig.  99. 


over  a  spur  upon  the  cuspid  band  to  accomplish  the  same 

purpose  more  conveniently. 

Dr.  Farrar's  device  for  effecting   the  same  movement  is 

shown  in  Fig.  99. 

It  consists  of  a  narrow  ribbon  of  gold,  long  enough  to  en- 
close the  cuspid  tooth 
and  some  tooth  back 
of  the  space  it  is  to 
occupy.  The  ends  of 
this  ribbon  nearly 
meet  on  the  buccal 
side  of  the  teeth,  and 
after  being  reenforced 
with  studs  of  heavy 
gold,  the  anterior  one 
being  simply  drilled 
and  the  posterior  one 
drilled  and  threaded, 
they    are    connected 

Traction  Apparatus.    (Farrar.)  "j^y    meaUS    of  a    gold 

screw.  The  turning  of  the  screw  brings  the  ribbon  ends 
nearer  together,  and  causes  corresponding  traction  on  the 
misplaced  tooth.     The  ribbon,  at  suitable  places,  has  ears  or 

tips  attached  to 
it,  intended  to 
rest  upon  the 
masticating  or 
inclined  sur- 
faces of  the  en- 
closed teeth  and 
prevent  the 
band  from  slip- 
ping up  and  irri- 
tating the  gum. 
Prof     E.     T. 

Appliance  for  Retraction.    (Darby.)  Darby's  plan  for 


Fig.  100. 


IRREGULAR    CUSPIDS.  145 

producing  the  same  movement  is  by  the  use  of  a  rubber 
plate,  a  gold  encasement  for  the  cuspid  and  a  gold  screw  for 
.connecting  the  two  and  producing  the  required  tension. 
Fig.  100  is  drawn  from  one  of  his  models,  and  represents 
the  fixture  in  position.  The  case  was  that  of  a  young 
lady,  fourteen  years  of  age,  who  applied  for  the  correction 
of  irregularity  of  the  anterior  teeth.  As  will  be  noticed 
in  the  illustration,  both  laterals  and  the  right  central 
were  inside  the  proper  line  of  the  arch,  while  the  left 
central  was  outside  of  it.  Space  was  needed  to  bring  these 
teeth  into  j^osition,  and  to  obtain  it  the  left  cuspid  had  to  be 
moved  backward  in  the  arch.  Opportunity  for  so  doing 
was  afforded  by  the  absence  of  the  first  bicuspid. 

To  move  the  cuspid  backward,  and  to  assist  in  accomplish- 
ing other  movements,  a  rubber  plate  covering  the  arch  and 
capping  the  molar  teeth  was  constructed,  and  into  it  on  the 
buccal  surface  was  inserted  a  gold  stud  or  ear,  drilled  and 
tapped.  A  gold  helmet  to  cover  the  entire  crown  of  the 
cuspid  was  then  constructed,  with  a  projection  on  the  labial 
surface  drilled  for  the  passage  of  the  traction  screw.  After 
this  helmet  was  cemented  in  place  with  phosphate  of  zinc, 
and  the  plate  inserted,  the  two  were  connected  by  means  of 
a  long  gold  screw.  Twice  each  day  this  screw  was  turned, 
until  the  cuspid  was  brought  almost  into  contact  with  the 
second  bicuspid. 

While  this  movement  was  progressing,  other  objects  were 
being  accomplished.  The  rubber  plate  when  first  inserted 
had  a  piano-wire  spring  attached  to  its  palatal  surface  to 
force  forward  the  right  central.  This  accomplished,  the 
spring  was  removed  and  rubber  added  to  the  plate  to  keep 
this  tooth  in  its  new  position.  Two  new  piano-wire  springs 
were  next  inserted  to  spread  apart  and  press  forward  the 
laterals,  as  shown  in  cut.  They  were  brought  into  position 
by  the  time  the  cuspid  had  been  drawn  sufficiently  back- 
ward. 

The  helmet  and  screw  were  now  removed  and  a  piece  of 


146 


ORTHODONTIA. 


Fro.  101. 


piano-wire,  doubled  and  bent  to  proper  shape,  was  inserted 
in  the  hole  of  the  gold  stud  in  the  rubber  jDlate,  in  such  a 
way  that  the  end  would  rest  upon  the  outstanding  central. 
and  force  it  into  line. 

The  case  as  corrected  is  shown  in  Fig.  101.  The  entire 
work  of  correction,  with  its  varied  movements,  occupied 
but  five  month's  time,  and  was  accomplished  by  the  use  of 

a  single  plate  with  its 
different  attachments. 
To  retain  the  teeth  in 
position  a  rubber 
plate  was  worn  cov- 
ering the  arch  and 
having  a  gold  T  in- 
serted to  pass  between 
the  centrals. 

Where  the  occlu- 
sion of  the  teeth 
would  not  contra- 
indicate  its  employ- 
ment, an  outstanding  cuspid  may  be  drawn  inward  by  means 
of  a  screw  operating  between  the  tooth  to  be  moved  and 
those  used  as  anchorages. 

Fig.  102  represents  a 
case  of  this  character, 
where,  in  addition  to  the 
firmness  of  the  tooth,  the 
patient  resided  at  such  a 
distance  from  the  dentist 
that  a  visit  to  him  could 
be  made  only  at  intervals 
of  two  or  three  weeks.  It 
was  therefore  necessary  to 
devise  an  appliance  of 
such  character  that  it 
could  not  be  removed  or 


J 


Corrected  Case. 


Fig.  102. 


Gold  Box  and  Screw  Drawing  in  Cuspid. 


IRREGULAR    CUSPIDS. 


147 


misplaced,  and  with  a  sufficiency  of  power  that  might  be 
regulated  by  the  patient  herself.  The  appliance  shown  in 
cut,  consists  of  two  platinum  bands  made  to  fit  the  mis- 
placed cuspid  and  opposite  molar  respectively,  and  cemented 
to  these  teeth.  To  the  palatal  surface  of  each  of  these  bands 
was  soldered  a  gold  ring,  which  served  as  point  of  attachment 
for  the  gold  box  and  screw,  which  operated  between  them. 

One    end    of   the    gold  Fig.  103. 

box  was  bushed  and 
thread-cut  to  receive  the 
gold  screw,  which  at  the 
opposite  end  was  bent  into 
the  form  of  a  hook  to  en- 
gage with  the  ring  on  the 
cuspid  band.  The  other 
end  of  the  box  was  fitted 
with  a  smooth  gold  wire, 

with  a  head  on  one  end  to      completed  case  with  Retaining  Appliance. 

serve  as  a  swivel,  and  a  hook  on  the  other  to  attach  to  the 
ring  on  the  molar  band.  Turning  the  box  with  a  wrench 
drew    the   screw   in-  Fig.  104. 

ward,  and  with  it  the 
cuspid  tooth.  Using 
a  single  molar  for 
anchorage  in  the 
movement  of  a  cus- 
pid was  scarcely  in 
accord  with  correct 
practice,  but  in  this  -"""^i^ 
case  there  was  no  kJ'  ^,  t 
alternative.  In  draw-      "% 

ing    the    cuspid    to  combination  Appliance  loi  Drawing  mCuspid.  (Angle) 

place,  the  molar  was  also  moved  somewhat  inward  and  for- 
ward, but  it  soon  resumed  its  former  position  after  being 
relieved  from  duty.  The  corrected  tooth  was  retainedfin 
place  by  having  cemented  to  it  the  small  band  and  bar 
appliance  shown  in  position  and  separately  in  Fig.  103. 


>0' 

It 


148  ORTHODONTIA. 

Aiiotlier  appliance  of  the  same  general  character,  but 
different  in  construction,  and  designed  by  Prof.  Angle,  is 
illustrated  in  Fig.  104.     It  is  described  as  follows : — 

"  The  cuspid  tooth  is  banded  and  a  piece  of  gold  wire, 
bent  sharply  at  right  angles,  is  hooked  into  a  pipe  soldered 
to  the  surface.  The  other  end  of  the  wire  is  soldered  to  a 
pipe  through  which  the  small  traction  screw  is  slipped,  and 
against  which  the  nut  works. 

"  The  other  end  of  the  traction  screw  is  hooked  into  a 
pipe,  soldered  to  a  band,  encircling  the  first  molar.  The 
anchorage  of  this  tooth  is  further  reinforced  by  a  piece  of 
the  gold  wire  which  is  slipped  through  a  tube  soldered  to 
the  buccal  surface  of  this  band,  the  end  of  the  wire  resting 
against  the  adjoining  teeth." 

Occasionally  it  is  possible  to  move  a  cuspid  inward  and 
at  the  same  time  provide  room  for  its  accommodation  by 
j)ressing  the  adjoining  teeth  apart. 

Fig.  105.  Fig.  106. 


Creating  Space  and  Moving  in  Cuspid.    (Hatteson.) 

Prof  Matteson*  illustrates  and  describes  the  use  of  a 
novel,  but  simple,  fixture  for  jDroviding  space  and  moving  a 
tooth  into  line  at  the  same  time.  It  is  shown  in  position  in 
Figs.  105  and  106.  It  consists  of  two  flexible  metal  strips 
attached  to  and  held  apart  at  their  inner  ends  by  a  suitably- 
shaped  wire  made  long  enough  to  rest  upon  the  palatal  sur- 
faces of  the  two  teeth  bordering  the  space  to  be  occupied  by 
the  cuspid.     At  their  outer  extremities  these -metal  bands 

*  Dental  Cosmos,  Vol.  XXXIV.,  p.  247. 


IRREGULAR    CUSPIDS. 


149 


Fig.  Ifn 


were  arranged  to  engage  with  a  curved  bolt  and  nut  over- 
lying the  outstanding  cusjjid  in  such  a  way  that  when  in 
position,  as  shown,  the  turning  of  the  nut  would  draw  the 
ends  of  the  strips  toward  one  another  and  thus  force  the 
cuspid  inward  at  the  same  time  that  the  adjoining  teeth 
were  forced  aj^art  to  provide  accommodation  for  it. 

Fig.  105  shows  the  appliance  as  first  used  and  Fig.  106  the 
same  with  a  longer  wire  substituted  for  the  shorter  one  after 
the  latter  was  rendered  unserviceable  by  the  moving  of  the 
tooth. 

In  the  case  in  hand,  after  the  preliminary  wedging,  only 
two  weeks'  time  was  consumed  in  bringing  the  cuspid  into 
place  with  the  appli- 
ance, as  described,  al- 
though the  patient  was 
a  well-developed  man 
twenty-two  years  of  age. 

The  tooth  was  re- 
tained in  place  by 
means  of  a  tubed  band 
cemented  to  it  with  wire 
inserted  to  rest  against 
adjoining  teeth,  as 
shown  in  Fig.  107. 

When  a  superior  cusjDid  erupts  inside  of  the  arch  the  dif- 
ficulties attending  its  being  brought  into  position  are  far 
greater  than  when  it  erupts  externally.  This  is  partly  due 
to  the  fact  that  the  sjiace  between  it  and  the  opposite  side  of 
the  arch  is  too  limited  to  admit  of  the  use  of  some  of  our 
best  power-yielding  ajjpliances  and  partly,  also,  to  the  thick- 
ness of  the  alveolar  process  in  which  it  is  embedded  and 
that  will  have  to  be  resorbed  before  the  tooth  can  assume  its 
proper  position. 

The  power  to  be  apj)lied  to  an  inlying  cuspid  must  neces- 
sarily be  very  great  to  carry  with  it  any  prospect  of  success. 
A  solid  Coffin  plate,  with  a  very  stiff  piano-wire  embedded 


Retainer.    (Matteson.) 


150 


ORTHODONTIA. 


Fig.  108. 


in  it  will  yield  the  greatest  amount  of  spring  power,  but 
where  this  is  insufficient  we  must  needs  resort  to  the  screw- 
jack  in  some  of  its  forms. 

An  appliance  of  Dr.  Angle's,  as  shown  in  Fig.  108,  for 

forcing  outward  a 
cuspid  is  neat,  simple 
and  effective. 

"The  base  of  the 
screw-jack  is  soldered 
to  a  band  encircling 
the  opposite  cuspid 
and  reinforced  by  a 
spur  resting  against 
the  first  bicuspid,  and 
also  by  the  large  trac- 

Screw-Jack  Moving  Out  Cuspid.    (Angle.)  tioU    SCrCW    wllich    is 

hooked  into  a  pipe  soldered  to  the  labial  surface  of  the  band 
and  passing  in  front  of  the  incisors  through  a  tube  soldered 
to  a  band  on  the  labial  surface  of  the  lateral  incisor,  against 
which  the  nut  works. 

"  In  this  case,  the  left  central  and  lateral  were  moved  for- 
ward in  the  line  of  the  arch,  thereby  closing  the  space 
between  the  centrals,  and,  at  the  same  time,  providing  space 
for  the  out-moving  cuspid.  The  large  screw  was  beaten 
flat  and  polished  before  insertion." 


CHAPTER  IV. 

MISPLACED  BICUSPIDS. 

The  l3icusj)icl  teeth,  both  superior  and  inferior,  are  often 
found  located  outside  or  inside  of  the  normal  arch  line,  but 
their  mal-position  is  not  of  as  frequent  occurrence  as  that  of 
the  anterior  teeth. 

Their  position  out  of  line,  as  in  the  case  of  most  forms  of 
individual  irregularity,  is  due  to  lack  of  space  or  the  crowd- 
ing of  other  teeth.  Sometimes,  through  tardy  eruption,  their 
space  in  the  arch  has  been  encroached  upon  by  the  pressure 
of  the  erupting  cuspids  in  front,  as  well  as  the  forward-moving 
tendency  of  the  molars.  In  such  cases  one  or  both  of  the 
bicuspids  are  com]3elled  to  assume  a  position  outside  or 
inside  of  the  arch,  the  latter  being  the  one  they  most  com- 
monly take. 

Again,  their  predecessors,  the  deciduous  molars,  frequently 
have  their  crowns  destroyed  by  caries  long  before  the  time 
for  their  natural  removal,  while  their  roots  remain.  Induce- 
ment is  thus  offered  for  the  adjoining  teeth  to  occupy  part  of 
the  space,  and  the  bicuspids  are  forced  to  erupt  in  an  abnor- 
mal position. 

In  other  cases,  they  may  have  taken  their  places  in  line, 
or  nearly  so,  and  are  subsecjuently  forced  out  of  place  by  the 
effort  of  the  cuspids  to  occupy  their  places  in  the  arch.  The 
ease  with  which  they  may  be  forced  out  of  position  is  readily 
understood  when  we  consider  that  their  roots  are  conical  and 
rather  short,  and  that  they  are  placed  between  teeth  that  are 
firmly  set  and  have  either  a  single  long  root  firmly  implanted, 
like  the  cuspids,  or  several  roots,  like  the  molars.     Their  dis- 

151 


152  ORTHODONTIA. 

tinctly  convex:  approximal  surfaces  also  greatly  favor  their 
displacement. 

The  second  bicuspid  is  more  frequently  found  out  of  line 
than  the  first,  probably  because  of  its  later  eruption. 

The  lack  of  alignment  of  one  or  both  bicuspids  is  some- 
times associated  with  a  greater  or  less  degree  of  torsion,  but 
this  is  not  of  common  occurrence,  and  when  met  with  is 
either  corrected  in  the  act  of  bringing  the  tooth  into  line  or 
will  have  to  be  remedied  by  a  separate  operation  afterward. 

The  greater  or  less  difficulty  of  bringing  into  line  one  or 
more  bicuspids  situated  inside  of  the  arch  will  usually  be 
entirely  dependent  upon  the  amount  of  space  existing  for 
their  accommodation.  If  much  of  their  space  in  the  arch 
has  been  pre-occupied  by  adjacent  teeth,  these  will  first  have 
to  be  pressed  apart  to  afford  accommodation.  Should  full 
or  nearly  full  space  exist  for  them  in  the  arch,  they  may 
usually  be  forced  into  line  by  the  elasticity  of  a  vulcanite 
plate,  or.  of  metal  in  some  form  of  spring.  Where  it  is  de- 
signed that  the  moving  tooth  shall  make  room  for  itself 
as  it  advances,  the  greater  power  of  the-  screw-jack  will  be 
required. 

A  simple  method  of  moving  a  bicuspid,  either  upper  or 
lower,  outward  into  line  is  to  obtain  a  plaster  model  of  the 
jaw.  The  plaster  tooth  representing  the  one  to  be  moved 
should  then  be  cut  away  on  its  palatal  or  lingual  surface 
until  this  portion  of  it  is  in  line  with  the  same  surfaces  of 
the  adjoining  teeth.  A  vulcanite  plate  made  upon  this 
model  with  a  piece  of  piano-wire  embedded  in  its  central 
portion,  if  it  be  for  the  lower  jaw,  will,  by  its  elasticity,  soon 
bring  the  tooth  into  position.  Or,  we  may  make  the  plate 
upon  the  unaltered  model  and  then  insert  a  wooden  peg  in 
a  hole  drilled  in  the  plate  opposite  the  tooth  to  be  operated 
upon.  Or,  instead  of  the  wooden  peg,  a  metal  screw  may  be 
inserted  so  as  to  act  upon  the  tooth.  By  setting  the  screw 
well  into  the  rubber  plate,  it  may  be  elongated  by  unscrew- 
ing from  time  to  time  until  the  object  is  attained. 


IRREGULAR    BICUSPIDS. 


153 


Fig.  109. 


Talbot's  Vulcanite  Plate  and  Coiled  Spring 


Dr.  Talbot  has  devised  an  excellent  method  of  forcing  one 
or  more  bicuspids  into  line  by  means  of  a  coiled  spring  of 
piano-wire,  in  connec- 
tion with  a  rubber  plate 
to  hold  it  in  position 
and  properly  direct  its 
action.  Fig.  109  repre- 
sents the  appliance  in 
position.  Dr.  Talbot 
says :  *"A  thin,  narrow, 
close-fitting,  vulcanite 
plate  was  made,  and  a 
hole  drilled  through  the 
middle  of  it  opposite  the  centre  of  the  tooth  to  be  moved. 
In  the  other  side,  another  hole  was  drilled,  but  not  quite 
through  the  plate.  A  suitable 
spring,  Fig.  110,  was  then  made  of 
piano-wire,  having  a  single  coil  A, 
and  the  ends  of  its  arms  bent  at 
about  a  right  angle.  One  of  these 
ends,  C,  was  cut  short  to  enter  the 
corresponding  hole  in  the  plate,  and  the  other  end,  B,  left 
long  enough  to  go  through  the  plate  and  impinge  on  the 
lingual  surface  of  the  bicuspid,  leaving  a  full  eighth  of  an 
inch  between  that  arm  of  the  spring  and  the  plate,  as  is 
clearly  shown  by  Fig.  109,  where  the  spring  is  in  position  to 
act  upon  the  tooth  to  be  moved. 
Both  the  spring  and  the  plate 
may  be  removed  instantly,  either 
for  cleansing  purposes  or  to  in- 
crease the  power  of  the  spring  by 
spreading  its  arms  or  to  open  the 
coil  so  that  the  tooth  may  be  held  steady  at  the  point  to  which 
it  has  been    moved.      Fig.  Ill  shows  a  spring  having  two 


Coiled  Spring. 


Coiled  Spring. 


*Dental  Cosmos,  Vol.  XXVIII.,  pp.  286-7. 


154 


ORTHODONTIA. 


long  ends,  B  B,  which  is  designed  for  a  case  in  which  two 
such  teeth  are  to  be  moved  in  opposite  directions." 

The  advantage  of  this  appHance  is  that  it  operates  with- 
out occupying  any  of  the  space  between  the  teeth,  which  in 
most  cases  is  important. 

Where  there  is  no  great  crowding,  however,  Magill  bands 
may  be  attached  to  the  anchor  tooth  or  teeth  and  the  one  to 
be  moved,  and  the  Talbot  spring  made  to  rest  in  suitable  de- 
pressions formed  in  them.  In  this  way  the  objection  to  a 
removable  rubber  plate  may  be  done  away  with. 

Where  the  superior  power  of  the  screw-jack  is  to  be  taken 
advantage  of.  Dr.  Kingsley's  method  of  using  it  in  combina- 
tion with  a  slotted  vulcanite  j^late  is  one  of  the  best. 

The  accompanying  illustrations.  Figs.  112  and  113,  copied 


Fig.  113. 


Fig  112. 


Slotted  Vulcanite  Plates  with  Screw-Jack.    (Kingsley 


from  Dr.  Kingsley's  work,*  represent  some  of  the  ways  in 
which  he  accomplishes  movements,  slightly  varying  in  char- 
acter. Fig.  112  operated  to  move  outward  both  bicuspids  of 
the  left  side  inferior,  the  first  more  than  the  second;  while 
Fig.  113  moved  all  four  of  the  inferior  bicuspids. 

Where  it  is  desired  to  avoid  the  use  of  a  plate,  Magill 
bands,  re-enforced,  drilled  and  counter-sunk,  may  be 
cemented  to  the  teeth  to  be  moved  and  the  screw-jack  in- 
serted between  them.  Prof.  Angle's  device  for  expanding 
the  arch,  as  shown  and  described  on  page  104,  may  also  be 


*Loc.  cit. 


IRREGULAR    BICUSPIDS. 


155 


Fig.  114. 


advantageously  used  for  moving  outward  one  or  more  of  the 
bicuspids.  It  will  be  noticed  that  in  the  operation  of  this 
appliance  any  instanding  teeth  are  moved  outward  into  line 
before  real  expansion  of  the  arch  begins ;  if,  therefore,  the 
moving  of  individual  teeth  is  alone  desired,  operations  can 
be  suspended  as  soon  as  that  object  has  been  accomplished. 

The  small  size  of  the  screw-jack  in  the  Angle  device  is 
also  an  element  in  its  favor,  since  it  will  interfere  less  with 
the  movements  of  the  tongue  than  the  larger  ones  commonly 
used. 

In  addition  to  the  jDower  of  the  screw-jack,  it  has  the 
further  advantage  of  rapidity  of  action ;  so  that,  if  its  posi- 
tion in  the  mouth  should  somewhat  inconvenience  the 
patient,  it  would  do  so  only  for  a  very  short  time. 

Dr.  Jackson  has  very  ingeniously  adapted  his  spring 
and  crib  method 
to  the  moving  of 
bicuspids,as  shown 
in  the  following 
illustrations : — 

Fig.  114  illus- 
trates his  apj)li- 
ance  for  moving 
outward  two  first 
bicuspids. 

*  "A  base  wire 
is  shaped  to  the 
lingual  side  of  the 
anterior  teeth  and 
anchored  to  the 
bicuspids  by  means  of  single  crib  appliances.  To  each  of 
these  latter  is  attached  a  hook  or  eyelet  to  sustain  a  straight 
bar  of  spring  wire  that  is  sprung  over  the  anterior  teeth." 
By  this  means  the  bicuspids  may  be  moved  outward  and 
the  arch  flattened  in  front  at  the  same  time,  when  desired. 


Spring  and  Crib  Appliance.    (Jackson.) 


*  Dental  Cosmos,  Vol.  XXXIII.,  p.  1077  et  seq. 


156 


ORTHODONTIA. 


Fig.  115. 


For  moving  the  bicuspids  inward,  he  employs  a  device 
like  that  shown  in  Fig.  115. 

"  Thin  metal  is  fitted  to  the  labial  surfaces  of  the  teeth  to 

be  moved,  being 
made  to  extend  well 
towards  the  necks 
and  distal  surfaces  of 
the  teeth.  A  good- 
sized  spring  wire  is 
then  formed  to  fol- 
low the  outline  of  the 
anterior  teeth  on  their 
labial  surfaces  and 
extend  to  the  metal 
clasps,  to  which  it  is 

Moving  Bicuspids  Inward.     (Jackson.)  SOlclcred 

"  The  appliance  should  be  removed  from  time  to  time  and 
the  clasping  ends  of  the  spring  bent  toward  each  other  to 
exert  the  pressure  required." 

A  simple  wire  fixture,  by  the  same  writer,  for  moving 
either  outward  or  inward  a  single  bi- 
cuspid, is  shown  in  Fig.  116. 

"A  spring  wire  is  bent  in  the  form  of 
a  crib  surrounding  the  misplaced  tooth 
and  an  adjoining  one  on  each  side,  pass- 
ing well  up  toward  the  gum  on  the 
labial  and  lingual  sides,  with  the  ends 
of  the  spring  wire  terminating  and 
overlapping    upon    the    tooth     to    be 

Simple  Wire  Spring.  (Jackson.)  -i 

"  The  elasticity  of  the  spring  will  exert  the  necessary 
force  to  move  the  tooth." 


Fig.  116. 


CHAPTER  V. 

TORSION. 

For  want  of  a  better  term  the  word  torsion,  as  applied  to 
the  teeth,  is  used  to  signify  tliat  condition  in  which  a  tooth 
is  found  to  be  turned  upon  its  axis.  Rotation  refers  to  the 
act  of  twisting  or  turning  a  tooth  so  as  to  bring  it  into  nor- 
mal position.  Torsion,  therefore,  will  describe  the  condition, 
and  rotation  the  operation. 

Torsion  is  usually  due  to  some  abnormal  influence  opera- 
tive before  or  during  eruption.  Lack  of  space  will  often 
impel  a  tooth  during  eruption  to  turn  in  such  a  way  as  to 
present  its  smaller  diameter  toward  the  space  intended  for 
its  accommodation,  in  order  to  occupy  that  space  at  all.  A 
root,  or  even  a  23ortion  of  one,  will  also  often  cause  a  tooth 
to  partly  turn  in  its  socket  while  seeking  its  position  in  the 
arch.  Torsion  of  the  superior  central  incisors,  so  often  met 
with,  is  doubtless  due  in  the  majority  of  cases  to  undue 
thickness  of  the  median  alveolar  septum.  The  condition  is 
also  produced  after  eruption  by  the  crowding  of  adjoining 
teeth,  induced  by  some  unusual  j^ressure,  such  as  the  effort 
of  a  later  erupting  tooth  to  occupy  its  place  in  the  arch. 

Torsion  is  met  with  in  all  degrees  of  extent,  from  the 
slightest  prominence  of  one  corner  of  a  tooth  to  a  complete 
half-turn. 

It  occurs  generally  in  single-rooted  teeth,  or  in  those  with 
a  slightly  bifurcated  root ;  and  among  these,  those  with  roots 
most  nearly  round  are  the  ones  commonly  affected  on 
account  of  the  ease  with  which  they  can  be  made  to  turn 
upon  their  axes. 

At  times  cases  are  met  with  in  which  two  adjoining  teeth 
are  thus  affected,  usually  each  in  like  degree,  this  variety  of 
the  condition  being  known  as  Double  Torsion. 

157 


158  ORTHODONTIA. 

Rotation  is  usually  not  a  very  difficult  operation  in  itself, 
but  when  complicated  by  the  crowding  or  disarrangement 
of  adjoining  teeth  it  sometimes  proves  quite  troublesome. 

Where  there  is  sufficient  space  in  the  arch  to  accommodate 
the  tooth  after  it  has  been  turned,  we  have  simply  the  mat- 
ter of  rotation  to  deal  with,  but  when  such  is  not  the  case, 
our  first  efforts  must  be  directed  toward  providing  space. 
This  may  be  done,  if  the  deficiency  be  slight,  by  pressing 
apart  the  impinging  teeth  by  some  of  the  means  described 
on  page  128 ;  but  where  great  space  needs  to  be  provided,  and 
expansion  of  the  arch  is  not  indicated,  it  will  be  necessary 
to  extract  some  less  important  tooth  to  afford  opportunity 
for  bringing  the  turned  tooth  into  line.  In  the  case  of  teeth 
with  flat  crowns,  as  the  incisors,  we  may  adopt  either  of  two 
plans  for  turning  the  tooth,  viz. :  grasping  the  crown  through- 
out its  entire  circumference  and  applying  suitable  power,  or 
by  direct  pressure  upon  one  or  both  of  the  angles  that  are 
out  of  line.  With  teeth  having  round  crowns,  such  as  the 
cuspids,  we  are  limited  to  the  plan  of  making  attachment  to 
the  periphery  of  the  crown. 

At  one  time  it  was  difficult,  if  not  almost  impossible,  to 
grasp  a  tooth  so  securely  as  to  have  the  attachment  resist  the 
strain  of  the  applied  power,  but  since  the  introduction  of 
the  Magill  band  this  greatest  of  all  difficulties  associated 
with  rotation  has  been  overcome. 

One  of  the  simplest  and  most  effectual  methods  of  rota- 
ting a  flat-crowned  tooth  is  by  the  use  of  a  rubber  plate 
made  to  cover  the  palate  and  envelope  the  posterior  teeth  on 
either  side,  according  to  the  Coffin  plan.  To  the  palatal 
portion  of  the  plate  a  piano-wire  is  attached  so  as  to  bear 
upon  the  inner  corner  of  the  tooth  to  be  turned,  while  a 
similar  wire  imbedded  in  the  buccal  portion  of  the  plate  is 
arranged  to  press  upon  the  corner  that  projects.  The  bend- 
ing of  the  wires  from  time  to  time,  to  increase  the  tension, 
will  speedily  accomplish  the  desired  result. 

Where  only  one  corner  of  a  tooth  stands  out  of  line,  the 


TORSION.  159 

plate  just  described  may  be  modified  by  having  but  a  single 
wire  to  press  inward  the  outstanding  corner,  and  allowing 
the  rubber  plate  to  rest  firmly  against  the  corner  that  is  in 
line,  to  prevent  it-  from  turning. 

Opportunity  for  the  projecting  portion  of  the  tooth  to 
move  inward,  must,  of  course,  be  provided  by  cutting  away 
the  rubber  plate  at  this  j^oint. 

Another  way  of  rotating  a  tooth  is  to  fit  a  band  or  ferrule 
of  gold  or  i^latinum  to  it  with  a  headed  platinum  tooth-pin 
soldered  to  its  labial  face  near  the  angle  that  is  out  of  line. 
A  delicate  vulcanite  plate  is  then  made  to  fit  the  roof  of  the 
mouth,  and  into  it  at  a  suitable  point  is  screwed  a  threaded 
gold  wire  with  a  slight  curve  or  hook  on  its  end.  After  the 
band  is  cemented  to  the  tooth,  it  is  connected  with  the  gold 
hook  in  the  plate  by  means  of  a  rubber  ring.  Should  it  be 
desirable  to  change  the  point  of  attachment  on  the  plate,  it 
can  be  done  by  drilling  a  new  hole  at  the  desired  point,  and 
screwing  a  hook  into  it.  The  plate  can  be  removed  for 
cleansing  and  new  rubber  rings  applied  by  the  patient.  This 
plan  is  effective  in  cases  where  no  great  power  is  required. 

To   aviod   the  inconvenience  of  wearing   a 
plate  during  the  school-age,  the  author  many     ^^^-  ^^'■ 
years  ago  devised  a  small  and  inconspicuous        ^ 
appliance   for  rotating  a  single  incisor.     It  is  V-'^^^^^.w/ 
shown   in   outhne   in    Fig.    117,   and    is   con-  ^  '^,^f.  ^•^"^^^.'^ 

c>  '  Kotatmg  Device. 

structed  as  follows  : 

A  strip  of  platinous  gold  about  an  eighth  of  an  inch 
in  width,  and  gauge  No.  24  in  thickness,  is  bent  to  conform 
to  the  outline  that  we  wish  the  turned  tooth  and  its 
neighbor  to  describe  when  in  normal  position.  Each  end 
of  this  strip  is  bent  to  partly  encircle  the  disto-palatal  angle 
of  each  tooth,  after  which  another  strip  of  gold,  of  similar 
width  but  thinner,  is  soldered  to  the  centre  of  the  first  piece. 
This  last  piece  should  be  long  enough  to  extend  between 
the  teeth  and  embrace  the  protruding  edge  of  the  tooth  to  be 
turned. 


160  ORTHODONTIA. 

By  bending  this  arm  so  short  that  the  appliance  will  have 
to  be  sprung  into  place,  pressure  is  brought  to  bear  upon  the 
tooth  that  will  cause  it  to  rotate  in  its  socket.  The  appliance 
should  be  removed  each  day,  the  length  of  the  arm  shortened 
by  bending,  and  replaced.  To  guard  against  loss  or  accident, 
a  ligature  of  sewing  silk  should  be  tied  around  the  neck  of 
one  of  the  teeth  and  made  fast  to  the  appliance.  About 
ten  days  will  usually  suffice  to  bring  the  tooth  into  proper 
position. 

The  tooth  once  in  place,  is  readily  retained  by  means  of 
Fig.  118.        the  small  retainer  shown  in  Fig.  118.    In  its 

^^•^•""V"'^*^  construction,  similar  bands  are  made  to  fit 
^"**«J    both  the  corrected  tooth  and  its  neighbor, 

The  Author's  .    .        ,  ,  t  t  i 

Retaining  Fixture,  after  wliicli  they  are  joined  by  solder  at  the 
point  where  they  touched  when  in  place.  To  add  stiffness, 
another  strip  of  gold  should  be  soldered  to  the  palatal  sur- 
face of  the  fixture.  When  completed  and  polished,  it  is 
lined  with  phosphate  of  zinc  and  placed  in  position  upon 
the  teeth. 

By  the  use  of  this  retainer,  which  occupies  but  little  space, 
the  tooth  is  held  so  rigid  in  its  new  position  that  it  becomes 
firm  much  more  rapidly  than  it  would  under  other  circum- 
stances. Should  the  force  exerted  by  the  effort  of  the  cor- 
rected tooth  to  return  to  its  former  malposition  be  so  great 
as  to  affect  the  tooth  used  as  anchorage,  this  tendency  may 
119.  be  prevented  by  soldering  a 

spur  of  gold  to  the  appliance 
at  a  suitable  point,  and  allow- 
ing this  to  rest  against  some 
firm  tooth  near  by. 

A  case  in  the  practice  of 
the  author  will  illustrate  a 
ready  means  of  correcting  an 

Torsion  Caused  by  Supernumerary.         extreme  Case  of  torsiou.     The 

patient  was  a  Japanese  boy,  nine  years  of  age,  whose  upper 
denture  when  he  applied  for  treatment  presented  the  ap- 


TORSION. 


161 


Fig.  120. 


Bands  and  Rubber  Ring  for  Rotation. 


pearance  shown  in  Fig.  119.  The  left  deciduous  lateral  was 
still  in  place,  while  the  right  permanent  lateral  was  just 
appearing  through  the  gum.  Both  permanent  centrals  were 
fully  erupted,  but  owing  to  the  presence  of  a  supernumerary 
tooth  in  the  centre  of  the  arch  the  right  central  was  crowded 
far  out  of  its  j^lace  and  turned  upon  its  axis. 

After  extracting  the  supernumerary  and  the  deciduous 
lateral,  platinum  bands  were  fitted  to  the  centrals,  with  a  gold 
hook  soldered  to  each  at  points  that  would  furnish  the  great- 
est amount  of  tractile  power. 
After  the  bands  were  cemented 
in  place  a  rubber  ring  was 
stretched  from  tooth  to  tooth,  in 
the  manner  shown  in  Fig.  120. 

The  malposed  tooth  was  thus 
readily  brought  into  contact 
with  its  fellow,  and  at  the  same  time  considerably  straight- 
ened. Its  further  and  comjilete  rotation  was  then  accom- 
plished by  an  appliance  somewhat  similar  to  that  shown  in 
Fig.  117,  after  which  it  was  retained  by  the  retainer  shown  in 
Fig.  11<S.  As  the  left  central  had  been  somewhat  loosened  in 
the  act  of  rotating  its  fellow,  it  was  found  necessary,  in  order 
to  secure  stable  anchorage,  to  attach  a  spur  to  the  appliance 
and  have  this  rest  against  the  palatine  surface  of  the  right 
lateral,  which  was  by  this  time  Fig.  121. 

almost  fully  erupted.  In  six 
months  the  teeth  were  firm  in 
their  new  position,  as  shown  in 
Fig.  121. 

A  simple  and  very  efi:ectual 
method  of  accomplishing  the  rotation  of  any  tooth,  without 
regard  to  the  form  of  the  crown,  and  one,  too,  in  which  the 
use  of  a  plate  is  dispensed  with,  is  illustrated  in  Fig.  122. 
It  consists  of  a  platinum  or  gold  band  made  to  fit  the 
tooth  to  be  rotated,  and  having  an  extension  bar  of  heavy 
platinized  gold  soldered  to  its  labial  surface.     The  free  end 


Corrected  Case. 


162 


ORTHODONTIA. 


/'    7<^^^ 


of  the  bar  is  perforated  by  two  holes  for  Ugation  to  some 
firm  tooth,  usually  a  molar.  In  use,  the  band  is  cemented 
to  the  tooth  and  the  bar  sprung  down  and  ligated  to  the  tooth 
selected  for  anchorage.  The  innnense  leverage  of  this  bar 
will  quickly  compel  the  tooth  to  turn  in  its  socket.  As  its 
Fig.  122.  force    becomes    spent 

from  time  to  time  the  bar 
can  be  bent  outward 
with  pliers,  without  re- 
moving it  from  the 
tooth.  After  the  tooth 
has  been  brought  into 
proper  alignment,  it  is 
most  conveniently  held 
in  position  by  means  of 

Spring  Bar  and  Band  for  Rotation.  ^^jq     retainer    shoWU     iu 

Fig.  28.-  It  may  also  be  retained  by  a  rubber  plate  having 
a  gold  spur  to  pass  between  the  teeth  and  rest  upon  the  por- 
tion of  the  tooth  that  has  been  moved  inward. 

Prof.  Angle  has  imjDroved  this  appliance  by  making  the 
band  and  bar  detachable. 

The  band  is  fitted  with  a  section  of  German  silver  tubing- 
soldered  to  its  labial  surface,  parallel  with  the  cutting  edge 
Fig.  123.  „^f^  of  the  tooth.      Another  band,  with  a 

hook  or  catch  soldered  to  its  buccal 
surface,  is  fitted  to  a  bicuspid  or 
molar.  This  latter  band  also  has  a 
piece  of  tubing  soldered  horizontally 
to  its  palatine  surface,  through  which 
is  passed  a  piece  of  wire  intended  to 
rest  against  the  two  teeth  adjacent  to 
the  one  banded  and  thus  afford 
greater  resistance.  After  both  of 
these  bands  are  cemented  to  their  respective  teeth,  a  straight 
piece  of  piano-wire  is  inserted  in  the  tube  of  the  tooth  to  be 
turned,  and  bent  doAvn  and  caught  in  the  catch  on  the  other 


Rotation.    (Angle.) 


TORSION. 


163 


tooth,  as  shown  in  Fig.  123.  The  advantage  of  this  modifi- 
cation is,  that  a  weaker  or  stronger  wire  can  be  substituted 
at  will,  and  the  power  be  thus  readily  controlled.  When 
the  tooth  is  in  proper  line,  the  wire  is  removed  and  replaced 
by  a  shorter  one  resting  upon  an  adjoining  tooth.  This  acts 
as  a  retainer  by  keeping  the  tooth  in  position  until  it  has 
grown  firm.  The  retaining  wire  is  secured  by  means  of  a 
pin,  inserted  in  a  hole  drilled  through  both  tube  and  wire. 
Another  simple  device  devised  by  Dr.  Jackson*  for  rota- 
ting a  single  incisor  is 
illustrated  in  Fig.  124. 
It  consists  of  a  band  or 
collar,  made  to  encircle 
the  one  incisor,  to  which 
are  attached  upon  the 
labial  and  palatal  sur- 
faces two  lugs  to  receive 
a  U-shaped  wire.  One 
arm  of  this  wire  spring- 
lies  upon  the  labial  side 

of    the    teeth     and     pro-  Rotating  Device     (Jackson ) 

duces  pressure  upon  the  mesio-labial  corner  of  the  turned 
tooth  while  the  other  extends  along  the  palatal  surface  and 
presses  upon  the  disto-palatal  angle.  Pressure  in  opposite 
directions  is  thus  accomplished,  while  the  balancing  of  the 
two  forces  prevents  the  anchor  tooth  from  turning.  The 
appliance  is  too  small  to  in  any  way  interfere  with  speech  or 
occlusion. 

DOUBLE    TORSION. 

Where  two  adjoining  teeth,  as  the  superior  centrals,  are 
to  be  rotated  in  opposite  directions,  a  single  appliance  will 
often  accomplish  both  movements  at  the  same  time.  The 
appliance  devised  by  the  author  for  this  purpose  is  shown 
in  Fig.  125,  and  the  details  of  construction  in  Fig.  126.  It 
is  a  modification  of  the  appliance  for  single  rotation  shown 


*Dental  Cosmos,  Vol.  XXXIII.,  p.  1076. 


164  ORTHODONTIA. 

on  p.  159.  To  adapt  it  for  duty  in  turning  two  teeth,  instead 
of  the  single  strip  of  gold  j)assing  between  the  teeth,  two 
strips  are  bent  in  the  form  of  "  b  "  and  "  c."  These  are  made 
long  enough  to  be  bent  slightly  over  the  labial  surfaces  of 
^  the  teeth  to  be   turned,  extend    along   the 

mesial   surface   to   the   palatine,   and    then 
along  this  latter  almost  to  the  distal  angle. 
The  Author's  Device  After  being   proDcrly  shaped   according   to 

for  Double  Kotation.    ^  ^-^/-^-^--^^  ,'=, 

the  model,  they  are  clamped  together  and 
Fig.  126.        soldered    along    their    contiguous    surfaces. 

c. "1  r _g  This  part  is  then  placed  in  position  on  the 

-^   \  model,  and  the  long  arms  bent  to  conform  to 

^— ^iT*^-^  the  inner  surface  of  the  bar  "  a,"  after  which 
V'  it  is  removed,  soldered  to  "  a,"  and  the  part 

"  b  "  "  c "  reduced  in  thickness  by  filing, 
so  as  to  occupy  as  little  space  between  the  teeth  as  possible. 
When  properly  constructed  the  labial  part  of  the  appliance 
will  rest  against  the  teeth  just  at  or  slightly  'above  the  most 
prominent  points  of  their  convexity,  while  the  lingual  por- 
tion will  be  near  the  gum,  but  not  quite  touching  it,  and  the 
slightly  curved  ends  of  this  part  wdll  catch  just  above  the 
little  prominence  usually  found  at  the  disto-joalatine  angle 
near  the  gum. 

Thus  made  and  placed,  the  piece  cannot  become  displaced 
by  the  lip  or  tongue,  except  when  loosened  by  the  moving  of 
the  teeth.  As  will  readily  be  seen,  by  its  use  force  is  brought 
to  bear  upon  four  points  of  the  two  teeth  at  one  time. 

A  valuable  feature  of  the  appliance,  had  in  view  in  its 
devising,  is  that  it  occupies  but  one  interdental  space,  and 
thus  more  readily  favors  the  turning  of  teeth  that  are  more 
or  less  crowded. 

In  use,  the  patient  should  be  seen  each  day,  the  fixture 
removed  and  tightened  -by  bending  the  long  arms  slightly 
toward  the  smaller  ones  and  sprung  into  place. 

To  facilitate  its  introduction  in  the  first  instance,  a  piece 
of  rubber  should  be  placed  between  the  teeth  one  day  pre- 
vious to  the  insertion  of  the  appliance. 


TORSION. 


165 


As  in  the  case  of  the  apphance  for  single  rotation,  a  thread 
should  be  tied  around  one  of  the  teeth  and  attached  to  the 
front  bar  to  guard  against  the  swallowing  or  loss  of  the 
piece.  Fig.  127  represents  a  case  of  double  torsion  which  was 
corrected  in  ten  days'  time  by  the  use  of  the  appliance  just 
described,  the  patient  being  seen  every  day ;  while  Fig.  128 
shows  the  completed  operation.  After  the  teeth  are  in  posi- 
FiG.  127.  Fig.  128. 


''''i^ll'ltllllll'llilliii'ii 

Double  Torsion 


Corrected  Case. 


tion,  they  may  be  best  retained  by  means  of  the  retainer 
shown  in  Fig.  30. 

When  the  distal  corners  of  the  teeth  project  instead  of  the 
mesial,  the  appliance  described  is  rendered  equally  service- 
able by  reversing  its  position  and  placing  the  long  arm  on 
the  labial  surface.  Fig.  129  represents  a  case  of  this  char- 
acter, wdiile  Fig.  130  shows  the  vulcanite  plate  with  gold  wire 
bow  that  was  used  to  retain  the  teeth  after  correction.  A 
simpler  and  better  method  of  retention  would  have  been  to 
use  the  appliance  shown  in  Fig.  118. 

Prof.    Angle   has   devised    a   very   simple   and    effective 
m.ethod  of  accomplishing  double  rotation  where  the  mesial 
angles  protrude.     Upon  each  of  the  teeth  to  be  rotated  he 
places  Magill  bands  with  tubes  soldered  to  their  labial  faces . 
near  the  distal  angles.     One  tube  is  set  vertically  and  the 


Torsion  of  Centrals,  with  Distal  Angles 
Pointing  Outward 

Fig.  131. 


Retaining  Plate  on  Collected  Case 


Fig.  132. 


other  horizontally.  A  short  piece 
of  piano  or  German  silver  wire, 
bent  to  a  right  angle  at  one  end, 
is  inserted  into  these  tubes  and 
rotation  is  effected  by  the  elas- 
ticity of  the  wire. 

Two    views    of   the    appliance 
are  shown  in  Figs.  131  and  132. 
Once    in    position,    the    teeth 
are  retained  by  inserting  in  the 
tubes  a  suitably-shaped   piece  of 
non-elastic  gold  wire. 
Another  modification  of  the  Siegfried  spring,  designed  to 
produce  double  rotation  is  shown  in  Fig.  133.      The  central 

coil,  in  this  case,  rests  in  the  groove 
between  the  two  teeth,  while  the 
wings  engage  with  wire  loops  sol- 
dered to  the  bands  near  their  distal 
surfaces. 

As  the  force  of  the  spring  is  neces- 
sarily limited,  it  can  only  be  used  to 
advantage   on  teeth  of  very  young 
patients  and  in  cases  where  there  is 
sufficient  space  for  their  rotation. 


Angle's  Appliance  for 
Double  Rotation. 


Fig.  133. 


Siegfried  Coil  Spring 


CHAPTER  VI. 

CONTRACTED  ARCH. 

A  contracted  arch  may  be  due  to  lack  of  development, 
caused  by  late  or  mal-eruption  of  some  of  the  teeth ;  to  the 
loss  of  certain  of  the  permanent  teeth  soon  after  their  erujD- 
tion  ;  or  to  malposition  of  the  teeth  in  the  oj)posite  jaw. 

The  late  eruption  of  the  superior  cuspid  teeth,  where  their 
spaces  have  been  preoccupied  by  teeth  anterior  and  pos- 
terior to  them,  is  perhaps  the  most  frequent  cause  of  this 
deformity. 

In  some  cases,  the  contraction  is  limited  to  the  molar  and 
bicuspid  region ;  in  others,  to  the  anterior  alone ;  while  in 
others  still,  the  entire  arch  needs  expansion. 

The  enlargement  of  the  arch,  either  at  certain  points  or  in 
its  entirety,  may  be  accomplished  by  a  variety  of  methods. 

Where  lateral  expansion  is  desired,  it  may  usually  be 
brought  about  in  a  simple  manner  by  the  use  of  the  Coffin 
split-plate,  the  construction  and  ojjeration  of  which  are 
described  on  p.  106. 

Another  form  of  appliance,  intended  to  accomplish  the 
same  jiurpose  and  constructed  of  piano-wire  and  vulcanite, 
has  been  devised  by  Dr.  Talbot,  and  is  illustrated  in  Figs. 
134  and  135. 

In  his  description,  he  says:*  "A  (vulcanite)  plate  is  made 
to  fit  the  teeth  and  alveolar  process,  and  cut  away  so  that  the 
anterior  parts  extend  far  enough  forward  to  enclose  the 
teeth  to  be  moved.  A  j)iece  of  (piano)  wire  is  bent  into 
either  of  the  forms  shown  in  Fig.  135,  wherein  '  a '  is  the 
coil  and  fixed  point,  '  b  b '  movable  arms  extending  from 
'  a,'  and  '  c  c '  movable  arms  extending  from  '  b  b.'     Grooves 

*Talbot's  Irregularities  of  the  Teeth.     2d  Ed.,  p.  221. 
167 


168 


ORTHODONTIA. 


are  cut  into  the  anterior  and  posterior  parts  of  the  plate  to 
correspond  with  and  receive  the  points  '  b  b '   and   '  c  c' 


Fm.  134 


Fig.  136. 


Appliance  for  Lateral  Expansion     (Talbot )  Talbot  Springs. 

Holes  are  drilled  at  these-  points,  and  the  wires  tied  to  the 
rubber  plates.  In  order  that  the  anterior  teeth  may  be 
moved  with  the  greatest  force,  the  arms  are  so  adjusted  that 
the  greatest  pressure  is  exerted  on  the  anterior  parts  of  the 
plates.  This  appliance  is  readily  removed  for  cleansing,  and 
returned  to  place  by  the  patient." 

Prof.  Goddard  em- 
ploys the  Talbot 
spring  for  lateral  ex- 
pansion, dispensing 
with  the  rubber  plate 
and  -using  instead, 
band  and  bar  attach- 
ments to  the  teeth,  as 
shown  in  Fig.  136. 
The  cut  so  fully  illus- 
trates the  appliance 
that  very  little  ex- 
planation is  needed. 

The     holes     in     the     combination  Appliance  tor  Expansion.  (Goddard.) 

bars  on  either  side  are  for  the  reception  of  the  coiled  spring 


CONTRACTED    ARCH. 


169 


Fig.  137. 


which  can  be  ijlacecl  either  forward  or  backward,  according 
as  one  part  calls  for  more  expansion  than  the  other.  After 
the  arch  has  been  widened,  the  bent  wire  "  c  "  is  substituted 
for  the  coiled  spring,  and  retains  the  advantage  gained. 
The  long  wire  "  a  "  "  b  "  is  intended  to  be  used  where  any 
of  the  incisor  teeth  need  to  be  moved  forward.  In  such  case 
its  ends  are  inserted  into  the  tubes  on  the  bicuspid  bands  and 
rubber  rings  are  passed  over  it  and  the  in-lying  incisors.  To 
prevent  the  ends  of  this  wire  from  slipping  through  the  tubes 
they  may  be  threaded  and  supplied  with  a  nut,  as  shown  at 
"  b,"  or  they  may  be  bent  to  a  bayonet-shape  as  shown  at  "  a." 

A  somewhat  similar  appliance  for  use  in  the  lower  arch, 
also    devised    by   Prof. 
Goddard,   is  illustrated 
in- Fig.  137. 

In  this  case,  as  in  the 
other,  the  long  wire  was 
used  for  attachment  in 
drawing  forward  the  in- 
locked  laterals. 

Where  more  force  is 

required      than     can     be  Expansion  of  Lower  Arch.    (Goddard.) 

obtained  from  either  of  the  appliances  just  described,  it  can 
be  had  by  the  more 
direct  power  of  the 
screw-jack,  which 
hastens  the  opera- 
tion and  lessens  the 
period  of  inconven- 
ience to  the  patient. 
Fig.  138  shows  a 
simple  method  of 
using  the  screw 
and  the  manner  in 
which  it  can  be  ap- 
plied   m    dllierent  Expansion  by  Screw.    (Goddard  ) 


Fig.  138. 


170 


ORTHODONTIA. 


Fto.   139. 


locations  along  the  line  of  the  arch.  The  bands,  bars  and 
screw  are  preferably  made  of  German  silver.  The  screw  and 
tube  in  which  it  operates  being  of  the  Angle  pattern.  Other 
ways  of  using  the  screw  in  connection  with  a  vulcanite 
plate  are  shown  on  p.  154. 

When  expansion  of  the  anterior  portion  of  the  arch  is 
desired,  it  may  be  accomjilished  by  means  of  one  of  the 
appliances  shown  on  pp.  130  and  131,  or  by  a  modification 
of  the  Coffin    split  plate   devised  by  Prof.  Goddard.     The 

latter  is  shown  in  Fig.  139. 
As  will  be  seen,  there  are 
two  corrugated  piano-wires  at- 
tached to  the  vulcanite  plate, 
one  on  each  side  near  the 
free  margins,  while  the  j)late 
is  split  laterally  just  back  of 
the  incisor  teeth.  As  in  other 
split  plates  for  anterior  ex- 
pansion, this  plate  is  made  in 
one  piece  and  the  wires  ar- 
ranged so  that  their  anterior 
ends  are  embedded  in  the 
portion  to  be  detached,  while  the  posterior  ends  are  fastened 
to  the  main  body  of  the  plate.  After  the  comj^letion  of  the 
plate  the  front  portion  is  separated  by  means  of  a  jeweler's 
saw,  and  pressure  is  produced  by  stretching  the  wires  from 
time  to  time. 

The  anterior  portion  is  kept  down  to  its  place  by  being 
ligated  to  the  central  incisors.  In  using  this  form  of  plate 
the  author  has  found  it  more  convenient  to  hold  the  front 
portion  down  by  imbedding  in  the  plate  a  gold  spur,  to  pass 
between  the  centrals  in  the  free  space  near  the  gum.  He 
also  prefers  to  secure  the  main  portion  in  position  by  making 
the  plate  to  cover  and  grip  the  bicuspids  and  molars,  as  in 
the  Coffin  method,  instead  of  fastening  it  to  the  side  teeth 
with  ligatures.  The  appliance  is  admirably  adapted  to  the 
purpose  for  which  it  was  devised. 


(j'oddard's  Split  Vulcanite  Plate. 


CONTRACTED    ARCH.  171 

Where  expansion  of  the  entire  arch  is  desired,  a  better 
plan,  in  most  cases,  is  to  accomplish  it  by  separate  opera- 
tions. Lateral  expansion,  for  instance,  can  be  accomplished 
first,  and  after  the  bicuspids  and  molars  have  been  brought 
into  proper  position,  they  may  be  retained  by  means  of  a 
rubber  plate  covering  them.  This  plate  will  not  only  hold 
them  firmly,  but  serve  as  an  anchorage  to  which  other  fix- 
tures may  be  attached  for  the  expansion  of  the  anterior  por- 
tion of  the  arch,  as  in  the  Goddard  plan. 

The  details  of  a  case  of  general  expansion  of  the  superior 
arch,  may  be  of  interest  to  the  student. 

The  patient  was  a  boy  of  about  fifteen  years  of  age.  The 
inferior  arch  was  of  normal  size,  with  the  teeth  well  arranged. 
In  the  superior  arch,  all  of  the  teeth  except  the  cuspids  artic- 
ulated inside  of  the  lower  ones,  giving  the  patient  a  pinched 
or  contracted  appearance  in  the  region  of  the  upper  lip.  The 
laterals  were  almost  in  contact  with  the  first  bicuspids,  while 
the  cuspids  had  fully  erupted  outside  of  the  arch  and  were 
overlying  the  laterals. 

Extraction  was  not  indicated,  for  all  of  the  teeth  were 
needed  to  fill  the  arch  after  its  expansion. 

By  means  of  a  Cofiin  split-plate,  lateral  expansion  was 
accomplished  in  about  a  month,  so  that  the  bicuspids  and 
first  molar  on  each  side  occluded  normally  with  those  below. 
Next,  with  another  Cofiin  solid  plate  encasing  the  teeth  that 
had  been  moved,  and  with  two  piano-wires  attached,  the 
laterals  were  pressed  forward ;  after  which,  new  rubber  was 
added  to  the  ]3late  to  keep  these  teeth  in  position,  and  the 
wires  changed  to  press  the  centrals  forward  into  line  with  the 
laterals.  After  this  had  been  accomplished  there  was  still 
insufiicient  space  for  the  accommodation  of  the  cuspids,  and 
as  the  incisors  were  already  so  far  forward  that  j)ressure  could 
not  advantageously  be  brought  to  bear  upon  them  from  the 
rear,  another  plan  for  increasing  the  cuspid  space  was  decid- 
ed upon.  Magill  bands  were  made  to  fit  the  laterals,  with 
gold  spurs  extending  along  the  palatal  surfaces  of  the  cen- 


172 


ORTHODONTIA. 


Fig.  140. 


trals  to  insure  uniform  movement  of  the  four  incisors.  Plat- 
inum bands  were  also  attached  to  the  first  bicuspids.  All 
of  these  bands  we  reenforced  with  an  additional  piece  of  plat- 
inum soldered  to  the  portion  next  to  the  space.  Through 
these  reenforcements,  at  about  the  centre  of  the  tooth,  holes 
were  drilled  entirely  through  the  bands.  Piano-wire  was 
next  bent  into  the  form  of  small  U-shaped  springs  with  the 
ends  at  right  angles.  Grasping  these  near  the  neck  with  a 
pair  of  narrow-beaked  right-angle  forceps  transversely 
grooved  near  the  points  to  seize  the  wire,  the  springs  were 
placed  in  position  with  their  ends  resting  in  the  holes  of  the 
bands.  As,  from  time  to  time,  the  force  of  these  springs 
became  spent,  they  were  removed  and  their  power  renewed 
by  enlarging  their  curves.  Sufficient  additional  space  having 
been  gained  by  their  use,  the  cuspids  were  forced  into  posi- 
tion by  means 
of  a  Coffin  plate 
with  wires  at- 
tached to  the 
buccal  surfaces, 
extending  for- 
ward and  rest- 
ing upon  the  la- 
bial surfaces  of 
the  cuspids. 
The    appear- 

IncTL  iMH^  spui    l)^  Curved  Spring  and  Bands  anCO  of  the  arcll 

and  teeth  with  the  U-springs  in  position,  is  shown  in  Fig. 
140.  The  operations  were  not  hurried,  and  consumed  about 
one  year's  time. 

A  retaining  i^late  of  vulcanite  covering  the  roof  of  the 
mouth,  with  gold  loops  attached  to  overlie  and  retain  the 
cuspids,  was  worn  for  nearly  a  year. 

Another  case,  differing  somewhat  from  the  one  just  given, 
was  that  of  a  young  girl  about  eleven  years  of  age,  whose 
superior  arch  did  not  need  lateral  expansion,  but  recjuired 


CONTRACTED    ARCH. 


173 


Fig.  141. 


anterior  enlargement  to  accommodate  the  in-coming  cuspids. 
False  occlusion  of  the  superior  incisors  also  needed  correc- 
tion. Fig.  141  represents  the  case  as  it  presented.  The 
superior  centrals  met  the  lower  ones  edge  to  edge,  while  the 
superior  laterals  passed  inside 
of  the  lower  ones.  There  was 
very  little  room  between  the 
superior  laterals  and  first  bi- 
cuspids to  accommodate  the 
cuspids,  which,  slow  of  erup- 
tion, were  just  beginning  to 
make  their  appearance. 

The       treatment       required        ^^'^  Requiring  Anterior  j;xpansion. 

was  the  moving  of  the  laterals  and  centrals  so  as  to  overlap 
the  lower  ones,  and  the  moving  backward  of  the  bicuspids 
on  each  side  to  afi^ord  space  for  the  cuspids.  The  laterals 
were  first  moved  forward  into  line  with  the  centrals,  by  means 
of  the  plate  shown  in  Fig.  142.  This  accomplished,  the  ante- 
rior portion  of  the  arch  was  expanded  by  means  of  a  God- 
dard  split-plate. 

A  plain  vulcanite  plate,  covering  the  arch  and  touching  each 
tooth,  was  next  made,  and  Fre.  142. 

into  it  were  secured  on 
either  side  pieces  of  piano- 
wire  bent  to  right  angles 
at  their  free  ends,  the  bent 
portions  being  arranged  to 
rest  upon  and  press  against 
the  mesial  surfaces  of  the 
first  bicuspids  to  force  them 
backward.  The  plate  hav-  ^°*°  '''^'^  ''''  ^'^''^°^  ^^'^'^''  ''''''''"^■ 
ing  been  trimmed  to  admit  of  the  backward  moA^ement  of 
the  bicuspids,  full  space  for  the  cuspids  was  soon  gained. 

The  slow  eruption  of  the  cuspids  required  a  retaining  plate 
to  be  made,  armed  with  gold  spurs  at  suitable  points,  to 
keep  the  regulated  teeth  in  their  new  positions  and  await 
the  full  eruption  of  the  cuspids. 


174 


ORTHODONTIA. 


At  the  end  of  six  months  the  cuspids  had  assumed,  un- 
aided, their  proper  places  in  the  arch,  and  by  their  key-hke 
position  preserved  the  arrangement  without  the  further  aid 
of  any  retentive  apphance. 

The  case  had  previously  been  in  the  hands  of  two  den- 
tists, who  began  operations  for  correction,  and  it  therefore 
became  necessary  for  the  author  to  carry  it  forward  to 
completion. 

Had  he  been  consulted  in  the  beginning,  he  would  have 
advised  non-interference  until  two  years  later  when  the 
cuspids  would  have  been  partially  erupted,  and  more  nearly 
ready  to  assume  their  places  in  the  arch,  as  soon  as  room 
was  provided. 

In  this  way  the  wearing  of  a  retaining  plate,  to  await  the 
full  eruj^tion  of  the  cuspids,  would  have  been  avoided  and 
the  case  simplified. 

Prof  Angle  has  devised  a  neat  and  effective  apj)liance, 
constructed  entirely  of  metal,  for  the  lateral  expansion  of 
the  arch,  as  shown  in  Fig.  143. 

Like  the  Jackson  appliances,  it  utilizes  the  principle  of 

the  Coffin  spring  without 
the  objectionable  features 
of  the  vulcanite  plate.  It 
can  be  used  in  either  the 
upper  or  lower  arch  and 
where  no  greater  power 
than  the  spring  affords  is 
needed,  will  prove  very 
efficient. 

As  seen  in  the  cut,  a 
rubber  ligature  may  be 
attached  to  the  centre  of 
the   spring    and    be   con- 

Lateral  Expansion.  (Angle.)  nCCtcd    with    any  CrOSS-bar 

appliance  upon  the  incisors  for  drawing  them  inward  when 
such  additional  movement  is  desired. 


Fig.  143. 


CHAPTER  VII. 

SUPERIOE  PROTRUSION.  , 

This  deformity,  so  frequent!}"  met  with  in  our  day,  not 
only  destroys  all  harmony  of  expression,  but  so  strongly 
suggests  the  facial  characteristics  of  idiocy  as  to  be  particu- 
larly objectionable. 

Fig.  144  shows  the  relation  of  the  teeth  in  outline  and 
Fig.  145  the  facial  expression.  In  the  latter  will  be  noticed 
the  conspicuousness  of  the  superior  incisors  and  the  result- 
ant shortening  of  the  upper  lip. 

Fig.  144.  Fig.  145. 


Superior  Protrusion.     (Case.) 

The  causes  tending  to  produce  this  condition,  have  been 

briefly  considered  on  pages  24  and  25. 

There  are  two  varieties  of  this  deformity : — 

1st.  Where  the  deformity  is  confined  to  the  protrusion  of 

the  upper  teeth,  the  lower  ones  being  in  proper  position  and 

forming  the  normal  curve. 

175 


176 


ORTHODONTIA. 


2nd.  Where  the  teeth  of  both  jaws  are  at  fauh,  the  upper 
ones  protruding  while  the  lower  are  abnormally  inclined 
inward. 

Deformity  Confined  to  Upper  Jaw. — This  form  is  usually 
attributable  to  inheritance ;  to  abnormal  size  of  the  teeth  in 
the  superior  arch ;  or  to  the  mechanical  influence  of  pressure 
on  the  part  of  the  posterior  teeth.  It  is  the  more  easily 
corrected  on  account  of  the  operations  being  confined  to  a 
single  arch,  and  yet  the  attendant  difficulties  are  often  very 
great. 

In  most  cases  of  superior  protrusion,  the  inferior  incisors, 
from  lack  of  occlusion,  become  extruded  until  they  occlude 
with  the  base  of  the  crowns  of  the  superior  ones  or  possibly 
impinge  upon  the  gum  tissue  just  back  of  them.  In  this 
condition  they  interfere  with  and  prevent  the  inward  move- 
ment of  the  upi^er  teeth. 

The  first  step,  therefore,  in  such  case,  is  to  shorten  the 
inferior  incisors  by  forcing  them  back  into  their   alveoli 
and,  at  the  same  time,  to  open  the  bite  by  permitting  the 
extrusion  or  elongation  of  the  posterior  teeth.     Probably  the 
Pj(._  146  best   means    of    accomplishing 

this  double  result  is  by  the 
employment  of  a  vulcanite  bite- 
plate  as  shown  in  Fig.  146.  It 
is  a  plain  vulcanite  plate  made 
to  cover  the  roof  of  the  mouth 
and  thickened  in  front  to. 
receive  the  impact  of  the  lower 
incisors.  It  should  have  a 
>*  Mm__Jg^^  vacuum -chamber  to  help  retain 

Vtilcanite  Bite-plate.  ^^  i^l  ])lace. 

When  in  position  and  the  mouth  closed,  the  lower  incisors 
should  touch  the  plate  and  all  of  the  posterior  teeth  be  free 
from  contact.  In  the  act  of  mastication  the  lower  incisors 
will  be  gradually  forced  back  into  their  sockets  while  the 
bicuspids  and  molars,  from  lack  of  occlusion,  will  become 
elongated  and  thus  open  the  bite. 


SUPERIOR    PROTRUSION.  177 

To  produce  the  best  results,  this  plate  should  be  worn  for 
a  year  before  any  attempt  at  regulating  is  made.  At  the 
end  of  this  time  it  will  be  found  that  sufficient  space  exists 
between  the  upper  and  lower  anterior  teeth  to  allow  the 
former  to  be  retracted. 

If  space  exists  between  the  teeth  the  operation  will  simply 
consist  in  applying  force  sufficient  to  ^move  them  inward. 
If  the  teeth  be  in  contact  and  the  protrusion  is  slight,  space 
may  sometimes  be  gained  by  dressing  off  any  discoloration 
or  superficial  decay  from  the  approximal  surfaces  of  the  six 
anterior  teeth  with  sand-paper  discs  or  emory-cloth  strips, 
followed  by  thorough  polishing. 

B}^  this  means  the  author  has,  in  a  few  instances,  materi- 
ally improved  the  patient's  expression,  without  loss  of  teeth 
or  injury  to  tooth  substance.  The  space  once  gained,  the 
teeth  can  easily  be  brought  inward  by  the  use  of  a  Coffin 
plate,  cut  away  posteriorly  to  the  incisors,  and  having  gold 
hooks  attached  to  the  anterior  portions  of  the  plate  on  the 
buccal  surface.  A  rubber  band  caught  over  the  hook  on 
one  side,  carried  along  the  labial  surfaces  of  the  anterior 
teeth  and  attached  to  the  hook  on  the  opposite  side,  will 
generally  provide  the  required  tension.  Small  double  hooks, 
made  from  half-round  gold  wire  and  hung  over  the  cutting 
edges  of  the  centrals,  will,  by  their  second  curves,  support 
the  rubber  band  in  proper  place  and  keep  it  from  resting 
upon  and  irritating  the  soft  tissues.  Other  simple  means 
for  effecting  the  same  result,  will  readily  suggest  themselves 
to  the  operator.  Where  the  protrusion  is  of  greater  extent 
and  the  teeth  are  in  contact,  it  will  be  necessary  in  most 
cases  to  sacrifice  a  bicuspid  or  molar  on  one  or  both  sides  of 
the  mouth  to  obtain  sufficient  space  to  enable  the  anterior 
teeth  to  be  moved  backward  into  line. 

After  the  extraction  of  the  tooth  or  teeth  it  is  well  to  draw 
backward,  b}^  easy  stages,  the  teeth  on  either  side  anterior  to 
the  space,  to  and  including  the  cuspids.  The  subsecjuent 
drawing  in  of  the  four  incisors  will  then  be  a  comparatively 


178 


ORTHODONTIA. 


Fig.  147. 


easy  matter.  In  many  cases,  if  the  posterior  teeth  were 
used  as  anchorages  for  the  inward  movement  of  six  or  ten 
anterior  teeth,  they  would  be  more  hkely  to  move  forward 
than  to  cause  the  anterior  ones  to  be  forced  backward,  on 
account  of  the  disparity  of  resistance. 

A  number  of  methods  for  moving  backward  the  cuspid 
and  bicuspid   teeth   are   described    on   pp.  141  to  144.     A 

simple  plan  for 
drawing  in  the 
four  superior  inci- 
sors, is  shown  in 
Fig.  147.  Plati- 
num bands  are  fit- 
ted to  the  laterals, 
and  to  their  labial 
portions  are  sol- 
dered extensions  of 
gold,  to  cover  and 

Author's  Device  for  Retracting  the  Superior  Incisors.  rCSt  UDOn    the    lab- 

ial surfaces  of  the  adjoining  centrals.  A  plain  rubber  plate 
is  also  made  to  cover  the  palate,  with  a  gold  hook  inserted 
in  its  center.  The  bands  being  cemented  in  place,  rubber 
rings  are  slipped  under  the  extensions  and  carried  to  a  point 
between  the  centrals  and  laterals,  where  they  are  drawn  in 
and  over  the  gold  hook  in  the  plate.     By  their  contraction, 

all  four  of  the  inci- 
sors are  drawn  in- 
ward while  but  two 
of  them  are  banded. 
A  plan  differing 
somewhat  from  the 
one  just  described,  is 
that  of  Dr.  Kings- 
ley's,  illustrated  in 
Fig.  148.  The  band 
.  ,r  ,     .    „,  .  .    T,  .  overlying  the    incis- 

Gold  Bar  and  Vulcanite  Plate  for  Retraction.  -^       » 

(Kingsiey.)  ors   is   of  gold,   and 


Fig.  148. 


SUPERIOR    PROTRUSION. 


179 


Fig.  149. 


has  hooks  soldered  to  the  upper  edge  to  prevent  its  shpping 
up  to  the  gum.  It  is  also  fitted  with  a  thin  strip  of  gold  to 
pass  between  the  centrals,  the  free  end  of  which  is  connected 
with  the  center  of  a  vulcanite  plate  by  means  of  a  ring  cut 
from  rubber  tubing.  This  rubber  ring  is  made  fast  to  the 
plate  either  by  a  ligature  or  by  slipping  it  into  a  horse-shoe 
slot  cut  in  the  plate  for  the  purpose. 

In  many  cases  the  elasticity  of  rubber  does  not  provide 
sufficient  force  to  move  backward  the  anterior  teeth.  In 
such  event  advantage  may  be  taken  of  the  superior  power 
furnished  by  piano-wire.  An  excellent  plan  for  arranging 
and  anchoring  such  wires  is  furnished  by  Dr.  Wadsworth.* 
The  appliance  is  constructed  after  the  method  of  Dr.  Jack- 
son, and  is  illustrated  by  Fig.  149. 

In  his  description,  Dr.  Wadsworth  says : — 

"  A  vulcanite  plate 
was  fitted  to  the  roof 
of  the  mouth,  and 
well  cut  away  from 
the  lingual  surfaces 
of  the  front  teeth. 
Piano-wire  sj^rings  of 
No.  21  gauge  were 
vulcanized  into  the 
plate,  passing 
through  the  spaces 
made  by  the  removal 
of  the  first  bicuspids, 

and  following  around  from  each  side  of  the  labial  surfaces 
of  the  cuspids  and  incisors  were  made  to  pass  each  other  at 
the  median  line.  These  springs  were  bent  to  give  the 
required  pressure  on  the  teeth  to  be  moved  and  the  pressure 
increased  by  bending  the  springs  from  time  to  time  as  the 
teeth  were  moved  inward.  The  appliance  was  held  in  posi- 
tion by  clasps  made  from  No.  20  piano-wire  fitting"  the 
bicuspids  and  molars,  as  seen  in  cut. 

^Dental  Cosmos,  Vol.  XXXIII.,  p.  30. 


180 


ORTHODONTIA. 


Fig.  150. 


"  The  patient  was  seen  once  or  twice  each  week  to  increase' 
the  pressure  as  required  and  the  deformity  entirely  corrected 
in  three  months  and  a  half.  The  appliance  was  worn  con- 
tinuously, could  easily  be  removed  for  cleansing  and 
replaced  by  the  patient,  and  caused  no  pain  or  inconve- 
nience whatever." 

The  direct  and 
forcible  action  of 
the  screw  m  a  y 
b  e  conveniently 
brought  into  play 
by  means  of  the 
device  shown  in 
Fig.  150.  It  is  a 
vulcanite  plate 
covering  the  arch 
and  encasing  the 
molars,   to    which 

Appliance  for  Retraction.    (Tomes.)    (Perry.)  is  attached  a    lialf- 

round  gold  wire  bent  to  a  curve  and  long  enough  to  extend 
along  the  outer  surfaces  of  the  teeth  from  molar  to  molar. 
One  end  of  this  curved  wire  is  permanently  attached  to  the 
vulcanite  plate  while  the  other  terminates  in  a  threaded 
wire,  which  engages  with  a  gold  nut  playing  in  a  slotted 
recess  of  the  plate  on  the  opposite  side.  Turning  the  nut 
shortens  the  bar  and  draws  the  teeth  inward. 

Another  appliance  operating  upon  the  same  principle 
but  possessing  additional  valuable  features  is  shown  in  Fig. 
151.  It  was  devised  by  Dr.  Louis  Jack  many  years  ago  and 
is  employed  by  him  not  only  for  moving  the  incisor  teeth  out- 
ward or  inward  but  for  the  purpose  of  aligning  any  of  the 
anterior  teeth. 

Dr.  Jack  described  the  appliance  as  follows  :* — "  It  is  com- 
posed of  two  pieces  of  vulcanite  joined  by  a  gold  band  or 
wire.  To  give  the  shoes  strength  and  to  enable  the  patient 
to  masticate  upon  them,  they  are  surfaced  with  gold  swaged 

■^International  Dental  Journal,  Jnly,  1893. 


SUPERIOR    PROTRUSION. 


181 


to  the  form  of  the  ends  of  the  teeth.      The  gold  facings  are 
vulcanized  to  the  shoes  in  their  proper  places. 

"  These  bases  of  support  for  the  movement  of  the  teeth  are 
connected  by  a  narrow  band  of  springy  gold,  one  end  of  the 
bar  being  secured  to  one  of  the  shoes,  the  other  end  being 
attached  to  the  opposite  shoe  by  a  male  screw  fitting  in  a 
s  c  r  e  w  -  c  u  t  Fje_  15l_ 

tube  or,  with 
proper  pre- 
cautions, vul- 
canized into 
a  projection 
on  the  outer 
plate  of  the 
shoe. 

"The  rea- 
son for  this 
plan  is  that 
by  turning 
the  free  end 
of  the  appli- 
ance the  bar 

may  be  reduced  or  increased  in  length.  If  in  any  given 
arch  a  tooth  or  more  is  projecting  and  others  are  depressed,, 
the  bar  is  brought  into  contact  with  the  most  prominent 
tooth,  and  a  piece  of  elastic  rubber  is  placed  between  this 
point  of  contact,  at  the  same  time  a  rubber  ring  is  carried 
over  each  of  the  teeth  which  are  within  the  arch  and  is 
drawn  through  a  hole  opposite  the  tooth  and  extended  to  a 
button.  On  the  next  day  the  bar  is  screwed  up  enough  to 
be  again  in  contact,  when  a  new  pressure  may  be  made  or 
the  tooth  is  rested,  as  the  conditions  require.  If  the 
depressed  teeth  are  sore,  they  may  be  rested  by  tying 
through  the  same  channel  as  the  ring  had  passed.  I  remove 
these  plates  daily,  each  time  making  a  gain  in  the  progress. 
It  is  important  to  make  this  daily  change  for  the  sake  of 


Regulating  Device.    (Jaclj.) 

A.  Occlusal  surface  of  the  movable  shoe,  showing  gold  facing. 

B.  Under  surface  of  fixed  shoe. 

C.  Screw  operating  in  threHded  cylinder  D. 
E.    Cleats  for  attachment  of  rubber  bands. 


182 


ORTHODONTIA. 


cleanliness,  the  patient  brushing  the  teeth  while  the  further 
preparations  are  being  made. 

"  Rotation  may  also  be  conducted  by  the  various  attach- 
ments made  for  that  purpose  by  connecting  the  rubber  band 
to  the  attachment,  and  many  modifications  of  this  simple 
description  will  occur  to  meet  the  exigencies  connected  with 
the  alignment  of  the  teeth. 

"  The  impression  of  the  teeth  should  be  taken  with  plaster. 
"  Some  preliminary  preparation  of  the  cast  is  required  to 
enable  these  shoes  to  hold  firmly  their  position.  They 
should  go  on  with  a  little  springiness.  The  cast  is  trimmed 
with  a  suitable  instrument  to  take  a  shaving  from  the  teeth 
at  the  neck,  and  also  a  shallow  groove  should  in  most 
instances  be  made  in  the  plaster,  at  the  gingival  margin.  The 
proper  amount  of  cutting  is  quickly  gained  by  experience. 
"  The  only  originality  in  connection  with  this  appliance 
is  the  division  of  the  old  form  of  upper  plate  which  was 
used  to  separate  interlocked  arches,  and  to  connect  these  by 
the  screw  at  one  end  of  the  bar." 

More .  recently  Dr.  Jack  has  modified  his  appliance  by 
having  the  bow  wire  connected  with  each  shoe  by  means  of 
Fig.  152.  threaded  tubes.     This 

improvement  increases 
its  range  of  applicabil- 
ity. It  is  shown  in 
Fig.  152. 

When  still  greater 
power  is  demanded,  as 
in  cases  where  it  is 
desired  to  draw  the 
six  anterior  teeth  in- 
ward by  one  operation, 

Improved  Appliance.    (Jack  )  q^    wllCrC    the    iucisors 

do  not  yield  readily  to  any  power  that  can  be  applied  within 
the  mouth,  anchorage  for  resistance  must  be  obtained  out- 
side.    Dr.  Kingsley,  we  believe,  was  the  first  to  suggest  and 


SUPERIOR    PROTRUSION.  183 

utilize  the  back  of  the  head  as  an  anchorage  for  appHances 
intended  to  produce  movements  of  the  teeth.  lUustrations 
of  a  fixture  of  this  character  will  be  found  in  his  work, 
pp.  133  and  134. 

Dr.  Farrar  also  devised  an  apparatus  for  the  same  purpose, 
but  it  is  somewhat  complicated  in  its  construction  and  man- 
ner of  adjustment. 

One  of  the  simj^lest  devices  of  this  character,  is  that  of 
Prof  C.  L.  Goddard.*  In  describing  the  construction  and 
use  of  his  appliance,  he  says:  "On  a  cast  of  the^ superior 
incisors  a  small  sheet  of  wax  was  placed,  covering  the  labial 
surfaces,  cutting  edges  and  part  of  the  lingual  surfaces.  In 
the  anterior  surface  of  this  wax  plate,  a  steel  wire  was 
imbedded,  curved  to  conform  to  the  arch,  and  extending 
laterally  about  one  inch  and  a  half  on  each  side.  The  ends 
of  this  wire  were  bent  in  the  form  of  hooks.  The  wax  plate 
and  wire  were  then  imbedded  in  a  flask  by  bending  the 
ends  of  the  wire  sufficiently  to  allow  them  accommodation 
inside  of  the  flask.     By 

the     methods     usually    ^^  Fig.  153. 

employed  in  vulcanite 
work,  a  plate  was  thus 
made  of  black   rubber 

.  ,     , ,  .  , ,       ,       ,         Goddard's  Steel  and  Vulcanite  Appliance  for 

witli  the  wire  attached,  Retraction, 

as  shown  in  Fig.  153. 

"  When  placed  on  the  patient's  teeth,  the  ends  of  the  wires 
j)rojected  from  the  corners  of  the  mouth  on  each  side  far 
enough  to  permit  elastic  bands  to  connect  them  with  a  cloth 
cap  on  the  patient's  head  without  touching  the  cheeks. 

"  The  cap  was  so  shaped  that  the  elastic  could  be  attached 
to  it  in  two  places  on  each  side,  one  above  and  one  below  the 
ear,  by  means  of  dress  hooks  sewed  to  the  cap  at. these 
points.  Round  silk-covered  elastic  cord  was  used,  and  the 
direction  of  the  force  could  be  varied  by  using  a  greater 

^Annual  of  the  Universal  Medical  Sciences,  for  1888,  Vol.  III.,  pp.  547- 
551.     F.  A.  Davis,  Philadelphia,  publisher. 


184 


ORTHODONTIA. 


number  of  strands  above  or  below  the  ear,  according  to  the 
requirements  of  the  case.  The  amount  of  force  was  easily 
varied  by  shortening  or  lengthening  these  cords.  Fig.  154 
shows  the  appliance  in  position. 


FiCx.  154. 


Appliance  in  Position.    (Goddard.) 

"  This  appliance  was  worn  at  night  only,  and  the  teeth 
were  soon  moved  back  to  the  desired  position.  The  inferior 
incisors  striking  the  bases  of  the  superior  ones,  were  moved 
backward  with  them.  After  the  teeth  were  in  proper  posi- 
tion, the  tension  of  the  elastic  cord  w^as  slightly  lessened  and 
the  appliance  worn  at  night  for  a  few  months  as  a  retain- 
ing appliance,  until  the  teeth  became  firm. 

For  the  reduction  of  superior  protrusion,  Prof  Angle's 
appliance  as  shown  in  Fig.  155,  commends  itself  for  simplic- 
ity and  efficiency.  It  consists  of  anchor  bands  (D)  for  the 
molar  teeth,  with  long  tubes  soldered  to  their  buccal  surfaces 
to  receive  the  wire  bow  spring  (C)  which  rests  in  front  in 
notched  projections  upon  bands  (A)  cemented  to  the  central 


SUPERIOR    PROTRUSION. 


185 


Fig.  155. 


incisors.  At  the  center  of  the  bow-s|)ring  is  soldered  a  short 
tube,  having  upon  its  labial  surface  a  rounded  projection  to 
receive  the 
standard 
(cupped  at 
its  free 
end)  of  the 
long  trac- 
tion bar  (E).  In 
use,  the  clamp- 
bands  (D)  are  at- 
tached to  the  an- 
chor teeth  and  the 
plain  bands  (A) 
cemented  to  the 
central  incisors. 
The  bow-spring  (C) 
is  now  placed  in 
position. 

Occipital  resistance  is  obtained  by  means  of  a  netted  cap 
fastened  to  a  circle  of  wire  fitted  to  the  head,  to  which  are 
attached  rubber  bands.  When  the  cupped  standard  of  the 
traction  bar  has  been  placed  over  the  central  spur  of  the 
bow-spring,  the  rubber  bands  of  the  cap  are  drawn  forward 
and  looped  over  the  curved  ends  of  the  traction  bar,  as 
shown  in  Fig.  156.  This  cap,  traction  bar  and  rubber 
bands  are  worn  only  at  night  on  account  of  their  conspic- 
uousness. 

During  the  day,  rubber  rings  (B)  are  caught  over  the 
tubes  on  the  molar  bands  and  secured  by  ligature  to  projec- 
tions on  the  bow-spring  in  the  region  of  the  cuspid  teeth. 
The  appliance  in  position,  as  worn  during  the  day,  is  illus- 
trated by  Fig.  157.  After  reduction  of  anterior  protrusion 
we  are  met  with  the  difficulty  of  retaining  the  results 
gained.  Although  the  posterior  teeth  in  many  cases  will 
not  furnish  the  resistance  necessary  for  drawing  the  anterior 


186 


ORTHODONTIA. 


Fig.  156. 


teeth  inward,  thej^  will  usually  answer  perfectly  for  retain- 
ing them  afterward.  Attachment  can  be  made  to  them 
either  by  means  of  a  rubber  plate  covering  the  roof  of  the 

mouth    and    extend- 
ing around  their  dis- 
tal   surfaces    in    the 
form  of  a  clasp,  or  by 
means  of  metal  bands 
cemented     to    them. 
In  the  former  case  a 
small  round  or  half 
round  gold  wire  may 
be    made    to    pass 
around    the    arch, 
touching  the  regular 
teeth  on  their  labial 
surfaces,  and  be   at- 
tached at  each  end  to 
the   rubber   plate   at 
convenient  points,  as 
where     teeth      have 
been   extracted. 
In     the     latter 
case    a    similar 
wire  may  be  sol- 
dered   to    the 
molar  bands,  or 
the  bands  may 
have  tubes  sol- 
dered   to    their 
buccal    surfaces 
and     the    wire, 
threaded  at  the 
extremities, 
passed  through 

Day  Appliance.    (Angle.)  these       and       re- 


Night  Appliance.    (Angle.) 

Fig.  157. 


SUPERIOR    PROTRUSION. 


187 


tained  by  Dieans  of  nuts  operating  upon  them.  In  either 
case  the  retaining  wire  should  have  short  gold  clips  attached 
to  it  in  front  to  engage  with  the  cutting  edges  of  at  least 
two  of  the  incisor  teeth. 

Where  it  is  desired  to  avoid  having  a  retaining  wire  pass 
entirely  around  the  front  of  the  arch,  a  rubber  retaining 
plate  may  be  made  with  a  gold  T  passing  between  the 
centrals  and  long  enough  to  rest  upon  all  four  of  the  incisors. 
Holding  these  teeth  firmly  in  place  will  also  keep  the  cus- 
pids in  line  through  lateral  pressure. 

In  all  cases  the  retaining  appliance  should  be  worn  for  a 
year  or  more,  until  we  are  fully  satisfied  that  the  teeth  are 
firm  in  their  new  positions  and  manifest  no  tendency  to 
change. 

The  author's  preferred  plan  for  employing  occipital  resist- 
ance    for  Fi(..  15g. 
retraction, 
differs     in 
certain 
particulars 
from  both 
the  Goddard  and 
Angle  methods. 

When  neces- 
sary, a  bite-plate 
similar  to  that 
shown  in  Fig. 
146  is  worn  for  a 
year  to  shorten 
the  inferior  inci- 
sors   and    allow 

the  posterior  teeth  Author's  combination  for  Retraction. 

both  above  and  below  to  elongate.  A  thin  silver  saddle  is 
then  swaged  to  cover  the  crowns  of  the  central  incisors,  to 
which  on  the  labial  surface  near  the  extremities  are  soldered 
two  headed  pins  taken  from  block  teeth.      In  the  center  of 


188 


ORTHODONTIA. 


Fig.  159. 


the  saddle  on  the  same  surface,  a  short  pin  or  post  of  iridio- 
platinum  is  also  inserted  to  engage  with  the  Angle  traction- 
bar,  as  shown  in  Fig.  158. 

The  molars  are  fitted  with  platinum  bands  to  which 
hooks  are  attached  on  the  buccal  surface.  The  skull-cap  is 
made  in  skeleton  form  of  inch-wide  strijDs  of  sheep-skin 
leather  sewed  together,  using  the  undyed  skin  for  patients 
with  light-colored  hair,  and  dark  leather  for  brunettes.  A 
pattern  of  paper  strips  is  first  made  and  fitted  to  the  head, 
and  from  this  the  one  of  leather  is  formed. 

Fig.  159  shows  one  side  of  the  cap  with  the  manner  of 
uniting  the  strips  where  they  pass  around  the  ear.  In 
use,  the  saddle  is  placed  in  position 
and  the  headed  pins  upon  it  are  con- 
nected with  the  hooks  on  the  molar 
bands  by  means  of  thin  rings  cut  from 
rubber  tubing. 

The  skull-cap  is  next  placed  upon  the 
head ;  the  cupped  post  of  the  traction 
bar  adjusted  to  the  central  pin  on  the 
saddle,  and  the  ends  of  this  bar  con- 
nected with  the  hooks  on  the  skull-cap 
by  means  of  elastics.  The  elastics  used 
are  the  ordinary  flat  rubber  bands, 
about  half  an  inch  wide,  cut  to  suitable  lengths  and  per- 
forated near  their  extremities.  The  entire  appliance  is  to 
be  worn  from  the  close  of  school  each  day  until  the  opening 
of  school  on  the  following  one,  but  during  school  hours  the 
skull-cap  and  traction  bar  are  dispensed  with. 

Thus,  for  sixteen  hours  out  of  the  twenty-four  constant 
force  is  being  exerted  upon  the  teeth,  while  during  the 
remaining  eight  hours  the  delicate  elastic  bands  retain  the 
advancement  made. 

After  correction,  the  teeth  should  be  retained  in  position 
for  a  year  by  constantly  wearing  the  silver  saddle  connected 
with  the  molar  bands  by  elastic  rubber  rings. 


Author's  Skull-Cap. 


SUPERIOR    PROTRUSION. 


189 


Movement  of  Roots  of  Teeth  Independently  of 
Crown  Movement. 

As  explained  in  Part  I.,  Chapter  VIII.,  the  movement  of 
the  crown  of  a  tooth  in  one  direction  is,  by  ordinary  meth- 
ods, accompanied  by  the  movement  of  the  root  in  an  oppo- 
site one,  some  portion  of  the  alveolus  forming  a  falcrum 
about  which  the  movement  takes  place.  Usually  these  two 
opposite  movements  are  desired  and  required  by  the  condi- 
tions of  the  case. 

At  times,  however,  it  is  desired  to  move  the  root  without 
changing  the  position  of  the  occlusal  portion  of  the  crown, 
while  in  other  cases  it  is  desirable  to  move  both  crown  and 
root  in  the  same  direction,  in  order  to  produce  proper  har- 
mony of  the  features. 

Attempts  have  been  made  from  time  to  time,  with  differ- 
ent appliances,  to  produce  these  latter  movements,  but  they 
were  not  satisfactory  in  character  until  in  1893,  Prof.  C.  S. 
Case  devised  a  plan  by  which  it  might  be  successfully 
accomplished.  It  consisted  in  attaching  an  extension  rod 
or  bar  to  a  band  on  a  tooth  and  applying  force  to  the  free 
end  of  this  bar  instead  of  to  the  band  on  the  crown.  In 
this  way,  he  not  only  obtained  increased  leverage,  but  was 
able  to  apply  his  force  at  a  point  opposite  to  the  root  some- 
where near  the  middle  of  its  length  and  move  it  in  any 
direction,  provided  he  held  the  occlusal  edge  immovably. 
In  addition  to  this, 
by  means  of  his 
ingenious  combi- 
nation of  power- 
bars,  tubes  and 
nuts,  if,  in  the  pro- 
gress of  the  case, 
it  became  neces- 
sary to  move  the 
crown     much     or 


Fig.  160. 


Increased  Leverage  for  Moving  Root.   (Case.) 


190 


ORTHODONTIA. 


little,  it  was  readily  accomplished  at  the  will  of  the  operator. 
The  device  and  the  philosophy  of  its  action  will  be  readily 
understood  by  an  examination  of  Fig.  160.  ^ 

The  cut  shows  the  device  as  arranged  for  moving  the  root 
outward  independently  of  the  crown.  When  it  is  desired  to 
move  the  root  in  the  opposite  direction,  the  power-bar  is 
arranged  to  rest  against  the  outer  side  of  the  extension  rod, 
and  the  nuts  are  made  to  operate  against  the  opposite  ends 
of  the  tubes  from  those  shown  in  the  illustration. 

While  a  single  root  or  crown  may  be  moved  by  this  plan, 
it  is  especially  designed  to  move  a  number  en  masse,  thus 
changing  the  facial  expression  of  the  parts  involved  in  any 
manner  desired. 

Fig.  161. 


Case's  Device  for  Root  Movement. 

Fig.  161  shows  the  complete  appliance  in  j)osition  for 
moving  the  roots  of  the  upper  incisors  outward  and  the 
lower  ones  inward,  without  materially  changing  the  posi- 
tion or  occlusion  of  the  crowns. 

In  describing  the  construction  of  his  appliance,  Prof. 
Case  says  :  * 


*  Dental  Cosmos,  Vol.  XXXVII.,  p.  917,  et  seq. 


SUPERIOR    PROTRUSION.  191 

"  For  material  for  regulating  appliances  I  prefer  German 
silver,  not  because  of  its  inexpensiveness,  but  because  much 
experience  with  all  other  metals  has  taught  me  that  none 
possess  the  same  favorable  qualities  for  this  work. 

"  The  bands  which  surround  the  teeth  should  be  wide  and 
thin.  If  No.  10  B.  &  S.  gauge  wire  is  rolled  to  four,  or  four 
and  a  half  thousandths  of  an  inch,  it  will  usually  be  about 
the  right  width.  This  banding  material  should  be  drawn 
firmly  around  the  natural  teeth,  the  ends  bent  sharply  to  a 
right-angle  for  the  joint.  When  these  are  soldered,  the 
joint  should  project  about  a  thirty-second  of  an  inch,  with 
its  sharp  corners  clipped.  Then  the  bands  should  be  care- 
fully fitted  and  burnished  to  the  teeth  with  the  joints  a  little 
to  one  side  of  the  center  of  their  anterior  faces,  to  allow  the 
upright  bar  to  take  its  proper  position,  exactly  in  the  center 
and  parallel  with  the  long  axis  of  the  tooth,  and  also  to 
serve  as  a  strengthening  girdle  to  the  attachment.  These 
and  other  small  details  may  seem  unnecessary,  and  yet, 
practically,  they  are  of  vital  importance  in  the  construction 
and  application  of  the  apparatus.  It  will  be  remembered 
that  I  originally  made  these  upright  bars  of  flattened  No.  18 
wire,  leaving  the  ends  long  enough  to  bend  over  when  in 
place,  and  clasp  the  force  bars.  The  operation  of  bending 
the  bars  was  often  a  difiicult  and  painful  one,  especially 
when  it  became  necessary  to  remove  and  recement  a  band. 

"  For  upright  bars  I  now  cut  pieces  from  Nos.  15  or  16 
wire,  about  three-fourths  of  an  inch  long.  These  are  filed 
slightly  at  the  middle  to  receive  the  band,  to  which  they  are 
firmly  soldered  in  the  position  described.  Then  they  are 
bent  and  filed  so  as  to  fit  perfectly  the  face  of  the  tooth 
against  which  they  are  to  rest.  They  should  also  follow  the 
curve  of  the  gum,  nearly  touching  it,  and  extend  above  its 
free  margin  about  one-fourth  of  an  inch.  The  perfecting  of 
these  can  only  be  accomplished  at  the  chair.  Finally  the 
bar  is  shaped  with  a  file  according  to  whether  force  is  to  be 
applied  in  an  anterior  or  a  posterior  direction. 


192    .  ORTHODONTIA. 

"  I  will  first  describe  the  method  of  procedure  for  cases 
which  require  a  forward  movement  of  the  roots.  In  cases  of 
this  character  I  have  never  found  it  necessary  to  apply 
force  to  other  roots  than  those  of  the  incisors.  The  cuspids 
are  usually  retarded  from  taking  their  positions  of  align- 
ment by  the  posterior  position  of  the  incisors,  and  are  fre- 
quently so  prominent  that  it  first  becomes  necessary  to  force 
the  crowns  of  the  incisors  forward  with  jack-screws  or  other- 
wise before  the  contouring  apparatus  can  be  effectively 
placed. 

"  Usually  in  those  conditions  when  the  cuspids  interfere, 
the  upper  ends  of  the  upright  bars  can  be  at  first  ligated  to 
the  power  bar,  and  thus  the  incisors  forced  forward  until 
the  power  bar  can  be  slipped  into  its  proper  position,  which, 
as  will  be  described,  is  always  back  of  the  upper  end  of  the 
upright  bars,  against  w^hich  it  presses  for  the  purpose  of 
exerting  force  as  high  as  possible  upon  the  roots  to  be 
moved. 

"  The  posterior  surface  of  that  portion  of  the  upright  bars 
which  stands  in  front  of  the  gum  is  filed  flat,  so  that  their 
antero-posterior  thickness  tapers  to  one-half  their  original 
diameter  at  the  ends,  where  they  serve  as  rests  for  the  power 
bar. 

"  The  anterior  surfaces  of  the  ends  are  rounded  and 
polished  to  a  thin  edge.  These  ends  should  not  extend 
above  the  upper  edge  of  the  power  bar,  unless  it  seems 
necessary  to  bend  them  at  the  extreme  end  to  form  a  catch 
to  prevent  the  power  bar  from  sliding  up. 

"  The  lower  ends  are  grooved  wdth  a  small  round  file  to 
receive  the  fulcrum  bar,  which  is  a  wire  (No.  22  or  20), 
threaded  only  at  one  end  in  the  No.  12  or  11  hole  of  the 
Martin  screw-plate,  the  other  end  being  held  in  place  by 
bending  it  back  after  passing  it  through  the  lower  anchorage 
tube. 

"  The  power  bar  should  be  made  with  the  greatest  care,  in 
order  that  it  be  of  the  required  rigidity  and  strength. 
Extra  hard  German  silver  wire.  No.  10,  should  be  drawn 


SUPERIOR    PROTRUSION.  193 

without  annealing  to  Nos.  13  to  16 — tliesize  being  regulated 
by  the  probable  power  necessary,  and  also  by  the  distance 
from  points  of  attachment  and  application.  In  other  words 
— when  the  anterior  end  of  the  anchorage  tube  {Pt,  Fig.  160) 
at  which  the  nut  works  is  even  with  the  bicuspids  or  at  no 
great  distance  from  the  points  of  applying  the  force,  less 
rigidity  of  the  bar  will  be  requisite  ;  and  again,  for  very 
young  patients  or  where  little  power  will  be  needed  for  the 
required  movements.  Ordinarily,  however,  No.  13  will  not 
be  found  too  large. 

"  When  it  has  been  drawn  to  the  proper  size  or  selected 
and  cut  about  the  right  length,  that  portion  which  is  to 
extend  between  the  right  and  left  first  bicuspids  should 
be  flattened  in  the  rollers  to  about  one-half  its  diameter. 
Then  it  should  be  bent  so  as  to  conform  to  the  shape  of  the 
gum  along  the  line  where  it  is  to  rest.  After  bending 
closely  over  the  cuspids,  it  should  extend  straight  back  into 
the  tubes,  into  which  its  threaded  ends  should  pass  from  one- 
half  to  three-fourths  of  an  inch. 

"  For  more  complete  direction  in  the  proper  method  of 
cutting  a  screw,  making  drills,  taps,  and  nuts,  I  refer  you  to 
other  writings  where  I  have  fully  described  the  process. 

"  The  construction  of  the  anchorage  attachment  which 
now  remains  to  be  described  is  of  the  greatest  importance  to 
the  ease  and  accuracy  of  its  application  and  subsequent 
usefulness. 

"  Two  molars,  or  the  first  molar  and  a  bicuspid,  and  some- 
times all  three,  should  be  selected  for  the  anchorage  teeth. 
When  these  are  accurately  fitted  with  wide  bands,  an 
impression  in  compound,  of  one  side  at  a  time,  including 
the  cuspids,  should  be  taken.  The  bands  should  then  be 
removed  from  the  teeth  without  bending,  and  carefully 
placed  in  their  proper  positions  in  the  impression,  which 
should  be  filled  with  Teague's  or  other  investing  com- 
pounds. You  now  have  the  bands  upon  a  small  model  that 
will  hold  them  firmly  in  their  proper  relative  positions 
during  all  the  soldering  process. 


194  ORTHODONTIA. 

"  As  the  position  and  mechanical  perfection  of  the  power 
tube  {Pt,  Fig.  160)  is  of  paramount  importance,  it  should 
receive  first  attention. 

"Select  a  strong  tube  one-half  or  three-fourths  of  an  inch 
long,  that  loosely  fits  the  threaded  end  of  the  bar.  Its 
anterior  end  should  be  placed  so  that  the  nut  will  work 
freely  upon  the  bar  without  impingement  upon  band,  tooth, 
or  gum,  and  it  should  take  a  direction  that  points  exactly 
to  that  place  upon  the  cuspid  over  which  the  power  bar  is  to 
extend.  In  order  to  strictly  observe  this  important 
direction,  it  usually  becomes  necessary  to  raise  one  or  the 
other  end  of  the  tube  from  the  bands  by  the  intervention  of 
lifts.  It  is  often  convenient  to  rest  its  posterior  end  upon  the 
lever  tube,  its  sharp  projecting  edges  being  rounded  so  as  not 
to  irritate  the  cheek. 

"  The  lever  tube  {Ft,  Fig.  160)  should  also  loosely  fit  its 
bar  or  wire,  and  be  soldered  directly  to  the  bands,  which  it 
firmly  unites,  and  thus  serves  to  give  statical  strength  to  the 
anchorage.  Their  direction  is  not  as  material  as  that  of  the 
power  tubes,  because  of  the  smallness  and  fiexibilitj'-  of  the 
lever  wire.  Their  posterior  ends  should  project  sufficiently 
free  from  the  other  parts  to  admit  of  the  working  of  the  nut. 
And  in  those  instances  where  reciprocating  rubber  bands  are 
to  extend  to  a  lower  appliance — the  advantage  of  which  has 
been  explained  elsewhere — I  allow  these  tubes  to  project  for 
that  purpose,  finding  them  much  more  convenient  than  the 
buttons  which  I  formerly  used. 

"  The  tubes  now  being  fitted  with  their  joints  turned 
toward  the  bands,  they  are  attached  with  an  abundance  of 
silver  solder,  the  bands  also  being  united  along  their 
approximal  surfaces. 

"  All  the  parts  which  have  undergone  the  soldering  pro- 
cess are  now  boiled  in  sulfuric  acid  to  remove  the  borax  and 
oxid,  after  which  the  entire  apparatus  is  polished  and 
heavily  gold-plated. 

"  The  teeth  being  properly  separated  with  wax  tape,  the 
anchorage  appliances  should  first  be  fitted  to  place  in  the 


SUPEKIOR    PROTRUSION. 


195 


Fig.  162. 


mouth,  and  the  cement  allowed  to  harden  before  proceeding 
further,  to  prevent  dislodgement  by  the  force  necessary 
in  placing  the  power  bar  in  position,  especially  as  it  often 
becomes  necessary  to  remove  and  rebend  the  bar  several 
times  in  the  final  perfecting  of  its  shape. 

"With  the  an- 
chorage appliances 
and  power  bar  in 
place,  the  bands  for 
the  anterior  teeth 
may  now  be  fitted 
and  cemented,  al- 
lowing   the    upper  Moving  Root  Inward.    (Case.) 

ends  of  the  upright  bars  to  rest  in  front  of  the  power  bar. 
Finally,  the  lever  bar  is  placed,  and  the  contouring  apparatus 
is  ready  to  commence  the  application  of  force  at  the  next 
sitting. 

"  An  apparatus  for  moving  the  roots  of  the  anterior  teeth 
in  a  posterior  direction  is  in  the  main  constructed  quite 
similarly.  (See  Fig.  162.)  The  power  bar  now  being  used 
for  traction  force,  the  same  rigidity  is  not  as  necessary  as  in 
the  other  apparatus.  I  find,  therefore,  that  a  No.  16  wire, 
not  flattened  in  front,  is  of  sufficient  size. 
.  "  The  other,  or  lever  bar,  the  force  of  which  acts  in  the 
opposite  direction  to  prevent  the  occluding  ends  of  the  teeth 
from  being  drawn  back,  should  be  as  large  as  No.  18.  It 
should  be  flattened  in  the  same  manner  described  for  the 
power  bar.  The  upper  ends  of  the  upright  bars  are  grooved 
on  their  anterior  surfaces  to  form  a  rest  for  the  power  bar ; 
while  a  shoulder  is  filed  on  the  posterior  surface  of  the  lower 
ends,  which  forms  a  slot,  when  in  j^lace,  for  the  flattened 
lever. bar  to  rest. 

"  It  being  understood  with  this  apparatus  that  the  power 
bar  nuts  work  at  the  posterior  ends  of  the  tubes,  while  those 
of  the  lever  bar  work  at  the  anterior  ends.  Proper  pro- 
visions for  this  arrangement  should  be  made  when  con- 
structing the  anchorage  appliances." 


CHAPTER  VIII. 


PROTRUSIOX    OF    THE    LOWER    JAW. 

This  condition,  one  of  the  most  unsightly  of  dental  deform- 
ities, giving  to  the  individual  a  rather  inhuman  expression 
and  interfering  greatly  with  speech  and  mastication,  is  C[uite 
frequently  met  with.  The  causes  probably  responsible  for 
its  inducement  are  given  on  p.  25. 

When  the  deformity  is  slight  it  ma}^  be  corrected,  or  at 

least  modified,  by  pressing  the  lower  incisors  inward  and  the 

upj)er  ones  outward ;  but  where  the  case  is  pronounced,  there 

seems  to  be  no  remedy  for  it  but  the  retraction  of  the  entire 

Fig.  163.  inferior  maxilla. 

Appliances  for 
moving  the  su- 
perior teeth  out- 
ward, are  shown 
in  Chaj^ter  VI., 
of  this  Part.  For 
retracting  the 
inferior  incisors. 
Dr.  Jackson  has 
illustrated  two 
devices,*  con- 
structed accord- 
ing to  his  meth- 
od, both  of  which 
have  the  merit  of  simplicity  and  effectiveness.  The  first  of 
these.  Fig.  163,  he  describes  as  follows : 

"  The  base-wire  No.  13  is  bent  into  a  semi-circle  to  con- 
form to  the  curve  of  the  arch  with  the  ends  anchored  with 
'  crib-attachments '  to  the  first  molars,  and  wire  clasps  extend- 
ing backward  to  the  distal  side  of  the  second  molars,  and  if 

*  Items  of  Interest.     June,  '97,  pp.  431,  432. 
196 


Ketraction  of  Inferior  Anterior  Teeth.    (Jackson.) 


INFERIOR    PROTRUSION. 


197 


Fig.    164. 


all  of  the  teeth  are  erupted,  a  crib  attachment  should  be 
placed  over  the  second  bicuspid  and  another  over  the  second 
molar,  the  base-wire  being  placed  back  of  the  incisors  a 
sufficient  distance  to  permit  of  their  movement.  A  spring 
wire,  about  No.  19,  is  shaped  to  conform  to  the  labial  side  of 
the  incisors  and  cuspids  near  the  gum,  passing  close  to  the 
distal  side  of  the  latter,  through  the  space  caused  by  the 
removals  of  the  bicuspids  and  bent  into  the  form  of  a  loop, 
between  the  base-wire  and  the  gum,  about  one-fourth  of  an 
inch,  with  the  ends  of  the  springs  soldered  to  the  '  crib- 
attachments  '  with  the  ends  of  the  base-wire.  The  desired 
pressure  is  caused  by  bending  the  sides  of  the  loops  toward 
one  another  from  time  to  time. 

"  If  there  are  no  spaces  between  the  teeth,  the  curves  of  the 
spring  should  be 
such  as  to  permit 
a  narrow  space  be- 
tween it  and  the 
distal  surface  of  the 
cuspids,  to  prevent 
the  teeth  from 
becoming  wedged 
together  du  ring- 
movement.  Clos- 
ing the  loops  in  the 
spring  in  the  man- 
ner     described, 

CaUSesmoreinward  Retraction  of  inferior  incisors.    (Jackson.) 

pressure  on  the  cuspids  than  incisors,  owing  to  the  natural 
elasticity  of  the  part  of  the  spring  that  passes  in  front  of  them. 
With  this  arrangement  the  cuspids  begin  to  move  before  the 
incisors,  which  lessens  the  danger  of  the  forward  movement 
of  the  teeth  used  for  anchorage,  it  being  understood  that  after 
teeth  have  commenced  to  move  less-  force  is  required  to  con- 
tinue their  movement. 

"In   Fig.   164   is   illustrated   another  form  of  appliance 


198  ORTHODONTIA. 

which  has  been  used  satisfactorily  for  moving  inward  all  of 
the  incisors  and  cuspids  at  one  time,  and  which  is  equally 
applicable  for  moving  a  less  number. 

"  It  is  made  with  a  base-wire,  anchored  in  the  same  man- 
ner as  the  previous  one,  it  being  arranged  back  of  the  teeth 
a  sufficient  distance  to  admit  of  their  moving  inward. 

"  Long  springs  are  attached  to  the  base-wire  on  the  inside, 
passing  to  the  outside  through '  the  spaces  caused  by  the 
extraction  of  the  first  bicuspids,  and  then  curved  forward  to 
rest  upon  the  labial  sides  of  the  teeth,  each  passing  beyond 
the  median  line  as  shown  in  the  illustration. 

"  The  variation  of  pressure  is  caused  by  shaping  the 
springs  so  as  to  impinge  upon  the  portion  of  the  arch  that 
it  is  desired  to  move,  usually  first  causing  pressure  at  the 
median  line.  Where  retraction  of  the  entire  maxilla  is 
demanded,  it  may  best  be  accomplished  by  using  some  form 
of  skull  cap,  and  connecting  it  with  a  padded  chin  piece  by 
means  of  strong  rubber  bands.  The  persistent  contraction 
of  the  rubber  will,  in  a  greater  or  less  time,  dependent 
largely  upon  the  extent  of  the  deformity  and  the  age  of  the 
patient,  bring  about  the  desired  change. 

"  In  the  accomplishment  of  this  retraction,  it  was  formerly 
supposed  to  be  brought  about  by  a  change  effected  at  the 
angle  of  the  jaw ;  but  the  more  plausible  hypothesis  is  the 
one  first  advanced  by  Dr.  Geo.  S.  Allen,  namely :  That  the 
pressure  applied  to  the  mental  region  causes  resorption  of 
the  posterior  wall  of  the  glenoid  cavity,  thus  permitting  the 
condyles  to  recede  and  articulate  somewhat  posteriorly  to 
their  former  position.  This  theory  as  to  the  physiological 
change  brought  about,  is  supported  by  the  fact  that  an  alter- 
ation of  form  in  the  gleniod  cavity  is  more  readily  accom- 
plished by  resorption,  than  a  bending  of  the  maxilla  at  its 
strongest  point." 

An  interesting  case  of  retraction  of  the  lower  jaw  was 
brought  before  the  Odontological  Society  of  New  York,  in 
1878,  by   Dr.    Allen.     I  quote   important  points   from  his 


INFERIOR    PROTRUSION. 


199 


description :  "  As  will  be  seen  from  the  photograph  (Fig. 
165),  taken  at  the  time  she  was  wearing  this  apparatus,  it 
consists  of  two  parts.  For  the  lower  part,  I  made  a  brass 
plate  to  fit  the  chin,  having  arms  with  hooked  ends  reaching 
to  a  point  just  below  the  point  of  the  chin.  These  arms 
were  arranged  in  such  yxg.  165. 

a  way  that  the  dis- 
tance between  them 
could  be  altered  at 
will,  by  simply  press- 
ing them  apart  or  to- 
gether. The  upper 
part  consisted  of  a 
simple  network  going 
over  the  head  and 
having  two  hooks  on 
each  side,  one  hook 
being  above  and  the 
other  below  the  ear. 
AVhen  this  apparatus 
was  completed  and  in 
use,  there  were  four 
ligatures  of  orclinar}'' 
elastic  rubber  pulling 
in  such  a  way  as  to  force  the  lower  jaw  almost  directly 
backward.  The  work  proceeded  very  rapidly,  so  that  at  the 
end  of  two  months  the  irregularity  was  almost  entirely 
cured.  I  see  no  reason  why,  in  all  such  cases,  either  this  or 
similar  methods  of  procedure  should  not  be  adopted.  I 
should  certainly,  if  any  similar  cases  presented  hereafter, 
even  at  twelve  or  thirteen  years  of  age,  before  attempting 
any  other  procedure,  try  this  first  and  thoroughly." 

In  forming  the  chin-piece  for  cases  of  this  character  the 
author  is  accustomed  to  take  a  plaster  impression  of  the 
chin  and  from  this  make  a  model.  The  model  is  then  over- 
laid with  a  piece  of  trial-plate  wax,  from  which,  after  being 


Allen's  Device  tor  Retraction  ot  Lower  Jaw. 


200 


ORTHODONTIA. 


Author's  Chia-piece 

Fig.  166. 


/^h 


varnished,  a  mould  in  sand  is  obtained  and  a  die  and  coun- 
terdie  made.     Between  tliese  a  piece  of  soft  and  heavy  brass 
Fig.  165.  plate  is  struck  up 

r^^^fev  and  drilled  full  of 

holes.    After  fash- 
ioning heavy  piano 
wires    to 
cross  the 
plate   and   extend 
sufficiently  beyond 
to  form  hooks,  they  are  soft- 
soldered   to   the  brass   plate 
and  the  latter  covered  with 
black  sheep-skin  with  a  thick 
layer  of  cotton  batting  laid 
between  the  two.      The  en- 
larged size  of  the  chin  piece 
will  admit  of  this.    The  piece 
thus  padded  will  fit  the  chin 
and  be  soft  enough   to  pre- 
vent pain  when  pres- 
sure   is    brought    to 
bear  upon  it.      It  is 
shown   in   Fig.    165. 
The  skull-cap   to  be 
worn   in    connection 
with  this  chin-piece  is 
shown  in  Fig.  159. 

A  chin-piece  de- 
vised and  used  by 
Dr.  Kingsley*  is 
shown  in  Fig.  166.  It 
is  made  of  "  sheet  cop- 
per (stiff'ened  around 
the  edge  with  non- 
elastic  steel  wire 
accurately    fitted    to 


*  Dental  Cosmos,  Vol.  XXXIV.,  p.  19. 


INFERIOR    PROTRUSION. 


201 


Fig.  168. 


a  plaster  cast  of  the  chin)  padded,  and  covered  with 
leather." 

The  skeleton  skull-cap,  used  by  Dr.  K.,  is  niade  of  leather 
and  is  shown  in  position  in  Fig.  167. 

Dr.  Winner,  of  Wilmington,  Del.,  furnishes  models  and 
description  of  a  case  somewhat  similar  to  that  of  Dr.  Allen, 
(Figs.  168  and  169.)  In 
this  case,  the  patient 
was  a  boy  fourteen  years 
of  age,  tall,  slender,  pos- 
sessing good  general 
health,  but  only  fair 
physical  strength.  The 
models  show  that  there 
was  a  bicuspid  lacking 
on  each  side  above, 
while  below  there  still 
remained  two  tempo- 
rary molars.  He  stated 
that  he  had  never  had 
any  teeth  extracted  by 
a  dentist,  so  it  is  probable 
that  the  two  bicuspids 
were  never  erupted. 
The  superior  centrals 
were  considerably  worn 
away  on  their  incisal 
edges  and  labial  sur- 
faces by  occlusion  with 
the-  lower  ones.  After 
extracting  the  decid- 
uous   molars    below,   a 

plate  was  made  covering  the  upper  posterior  teeth,  so 
arranged  that  in  addition  to  furnishing  a  masticating  sur- 
face it  acted  as  an  inclined  plane  in  helping  the  lower  jaw 
to  move  backward.     From  first  to  last  he  wore  an  occipito- 


Inferior  Protrusion.    (Winner.) 


Fig.    169. 


Case  Corrected. 


202 


ORTHODONTIA. 


Fm.  170. 


mental  sling,  as  illustrated  in  Garretson's  Oral  Surgery, 
increasing  the  tension  from  slight  at  first  to  as  tight  as 
could  be  borne  without  too  great  discomfort.  At  the  end  of 
nine  weeks  the  articulation  was  normal,  but  the  sling  was 
worn  for  several  weeks  longer,  Avithout  increased  tension, 
to  retain  the  satisfactory  result  secured.  The  wearing  of 
a  plate  in  the  upper  jaw  arranged  with  an  inclined  plane, 
as  described,  will  materially  assist  in  forcing  the  lower  jaw 
backward. 

Fig.  170  represents  a  form  of 
plate  used  by  the  author  in  forc- 
ing the  inferior  incisors  inward, 
and  the  superior  ones  slightly  out- 
ward in  cases  where  both  move- 
ments are  desired.  It  is  con- 
structed of  vulcanite  and  has  in- 
serted in  its  anterior  portion 
pieces  of  platinous  or  spring  gold 
plate  directly  opposite  the  incisors, 
and  arranged  to  rest. against  their 
lingual  surfaces  and  extend  below 
their  incisal  edges. 
To  hold  this  plate  in  place  and  resist  the  leverage  pro- 
duced by  biting  on  the  gold  projections  a  molar  on  each 
side  was  fitted  with  a  Magill  band,  to  the  linqual  side  of 
which  was  soldered  an  oval  lug  or  projection.  When  the 
plate  was  inserted  it  was  sprung  up  past  these  lugs,  and 
thus  securely  held  in  position.  Th^  patient  by  a  slight, 
dexterous  movement  could  remove  the  plate  for  cleansing 
and  then  reinsert  it. 

Fig.  171  illustrates  the  most  pronounced  case  of  this  class 
of  deformities  the  writer  has  ever  met  with.  The  patient 
was  a  man  of  about  forty  years  of  age  and  was  brought  by  a 
neighboring  dentist  for  consultation  as  to  whether  anything 
could  be  done  to  remedy  the  defect.  The  lower  jaw  was 
very  large  in  all  its  aspects,  while  the  upper  was  corres- 


Author's  Inclined-plane  Plate. 


INFERIOR    PROTRUSION. 


203 


Fig.  171. 


pondingi}^  small.  Although  the  lower  incisors  inclined 
decidedly  inward,  the  distance  from  the  incisal  edge  of  the 
lower  incisors  to  the  incisal  edge  of  the  upper  in  a  hori- 
zontal line  was  a  little  over  half  an  inch.  From  the  upper 
jaw  there  were  missing  the  right  lateral,  second  bicuspid 
and  first  molar ; 
while  on  the  left 
side  the  second 
bicuspid  and  two 
molars  were  ab- 
sent. In  the  lower 
jaw,  the  patient 
had  lost  twomolaif- 
and  a  bicuspid  on 
left  side,  and  the 
first  molar  on  the 
right.  All  of  the 
teeth  in  the  upper  jaw  passed  inside  of  the  lower,  except  the 
first  bicuspids,  whose  external  cusps  occluded  slightly 
wuth  the  anterior  lingual  cusps  of  the  opposite  molars  below. 
The  advanced  age  of  the  patient,  conjoined  with  the  con- 
ditions just  described,  placed  his  case  beyond  surgical 
remedy  and  he  was  so  informed.  A  plate  covering  and 
masking  the  natural  teeth  above  with  artificial  teeth 
mounted  outside  to  occlude  with  the  lower  ones  was 
suggested,  but  the  idea  did  not  please  him,  and  he  con- 
cluded to  pass  the  remaining  portion  of  his  life  as  he  had  the 
first,  so  far  as  his  dental  apparatus  was  concerned. 


Excessive  Prognathism. 


CHAPTER  IX. 

LACK    OF    OCCLUSION. 

This  deformity,  while  not  of  common  occurrence,  is  one 
most  difficult  of  correction.  It  is  characterized  by  a  failure 
on  the  part  of  a  number  of  teeth  to  occlude,  and  is  not  only 
liable  to  impart  a  lisp  to  the  speech  of  the  individual,  but 
also  renders  the  involved  teeth  entirely  useless  for  purposes 
of  mastication. 

The  causes  responsible  for  the  condition  are  at  best  diffi- 
cult to  determine,  and  vary  according  to  the  character  and 
location  of  the  deformity.  It  may  present  in  three  different 
forms. 

1.  Where  some  of  the  posterior  teeth  occlude  and  the 
anterior  ones  do  not. 

2.  Where  the  anterior  teeth  occlude  and  the  posterior  ones 
do  not. 

3.  Where  both  anterior  and  posterior  teeth  occlude  and 
the  intervening  side  teeth  fail  to  come  into  contact. 

The  first  may  be  designated : — 

Lack  of  Anterior  Occlusion. — The  cause  of  this  form  of 
deformity  has  been  variously  attributed  to  thumb-sucking, 
to  sleeping  with  the  mouth  open  and  to  derangement  of  the 
ar|,iculation  caused  by  ill-advised  extraction' of  some  of  the 
posterior  teeth ;  but  while  all  of  these  are  doubtless  respon- 
sible for  the  condition  in  many  instances,  it  is  probably 
more  frequently  caused  either  by  the  lack  of  alveolar 
development  in  the  incisor  region,  or  an  unaccountable 
variation  in  the  plane  of  the  alveolar  border  of  the  maxilla. 

At  first  glance  the  incisors  have  the  appearance  of  being 
too  short  in  their  crowns,  but  an  examination  will  usually 
show  that  they  are  of  normal  size  and  length  and  that  the 

204 


LACK    OF    ANTEEIOR    OCCLUSIOX. 


205 


Lack  of  Anterior  Occlusion.    (Baker.) 


process  and  possibly  the  maxilla  itself  is  responsible  for  the 
shortened  appearance. 

In  most  cases  it  will  be  found  that  both  arches  are  normal 
in  form  and  size,  that  Fig.  172. 

there  is  no  a  n  t  e  - 
version  or  introver- 
sion either  above  or 
below,  and  that  the 
superior  teeth  alone 
are  at  fault.  Fig. 
172  represents  a  case 
of  this  character,  in 
which  the  condition 
is  complicated  with 
considerable  irregu- 
larity of  both  superior  and  inferior  teeth,  the  model  being 
from  the  collection  of  Dr.  H.  A.  Baker. 

A  more  typical  case,  in  which  both  arches  are  normal  in 
size  and  outline  and  where  there  exists  a  simple  inability  to 
effect  a  closure  of  the  jaws  in  front,  is  shown  in  Fig.  173. 
The  model  w  a  s 
sent  to  the  author 
by  Dr.  Quattle- 
baum  of  Columbia, 
S.  C.  The  patient 
was  a  strong, 
healthy  girl,  fifteen 
years  of  age,  and 
no  cause  for  the 
deformity  could  be 
discovered.      T  h  e 

second    molars     on  Lack  of  Anterior  occlusion.    (Quattlebaum.) 

each  side,  above  and  below,  are  the  only  ones  that  come  into 
contact ;  and  while  the  first  molars  and  bicuspids  are  nearly 
in  contact,  the  anterior  teeth  are  quite  wide  apart  when  the 
jaws  are  closed. 


Fig    173 


206  ORTHODONTIA. 

Two  methods  of  treatment  suggest  themselves  in  cases  of 
this  character.  In  aggravated  cases,  in  young  subjects,  the 
better  plan  is  to  produce  pressure  upon  the  anterior  portion 
of  the  lower  jaw  by  means  of  a  skull-cap,  chin-piece  and 
rubber  bands,  as  described  and  illustrated  in  the  preceding- 
chapter.  The  only  modification  in  cases  like  this  being  that 
the  power  should  be  applied  in  an  almost  vertical  direction. 
An  apparatus  of  this  character,  worn  continuously  for  a  few 
months,  would  tend  to  tip  the  condyles  slightly  out  of  their 
sockets,  and  allow  the  latter  to  be  partially  filled  with  new 
osseous  material.  The  change  thus  produced  would  be  slow, 
but  the  result  satisfactory. 

Where  the  deformity  is  slight,  a  simpler  and  better  mode  of 
treatment  consists  in  grinding  off  the  cusps  and  occluding 
points  of  some  or  all  of  the  posterior  teeth  in  order  to 
shorten  the  bite  and  bring  the  anterior  ones  more  nearly 
together.  Much  of  this  cannot  be  done  without  denuding 
the  teeth  of  their  enamel  at  certain  points  and  exposing  the 
sensitive  dentin,  but  by  grinding  as  much  as  is  possible 
without  causing  too  great  pain  and  then  administering  an 
anaesthetic  and  continuing  the  grinding,  quite  an  improve- 
ment can  be  brought  about. 

The  sensitiveness  of  the  exposed  dentin  may  afterward  be 
obtunded  by  repeated  applications  of  either  chloride  of 
zinc,  caustic  potash  or  nitrate  of  silver.  Where  this  will  not 
avail  sufficiently,  it  may  be  advisable  to  devitalize  two 
or  more  of  the  teeth  most  interfering  with  occlusion  and 
then  continue  the  grinding  until  the  necessary  change  is 
effected.  The  devitalized  teeth,  of  course,  will  have  to  be 
subsecjuently  treated  and  filled. 

In  other  cases,  where  the  interference  of  one  or  two  teeth 
is  chiefly  responsible  for  the  condition,  extraction  may 
be  resorted  to.  In  some  instances  the  author  has  found 
it  necessary  both  to  extract  some  teeth  and  shorten  others  by 
grinding  in  order  to  obtain  even  a  moderate  degree  of 
improvement. 


LACK    OF    POSTERIOR    OCCLUSION.  207 

Lack  of  Posterior  Occlusion. — Cases  of  this  character  are 
ver}^  rarely  met  with,  and  when  not  comi^Hcated  with  other 
adverse  conditions,  such  as  extensive  decay,  may  usually  be 
corrected  by  mechanically  changing  the  relations  of  the 
superior  and  inferior  incisors  so  as  to  bring  them  into 
normal  occlusion.  After  this  has  been  done  the  posterior 
teeth  will,  in  time,  of  their  own  accord,  usually  become  suffi- 
ciently extruded  or  elongated  to  come  into  contact.  Should 
this  extrusion  fail  to  occur  unaided,  means  will  have  to 
be  adopted  to  bring  it  about.  If  any  of  the  unoccluding 
teeth  are  extensively  decayed,  the  matter  of  correction  will 
be  simplified,  for  we  can  then  crown  them,  and  in  so  doing 
add  to  their  length  sufficiently  to  bring  them  into  contact 
with  their  opponents.  A  case  involving  the  several  features 
just  alluded  to  and  the  means  adopted  for  their  remedy 
is   described    by  Dr.  Piq._  174. 

Willis.*  The  patient 
was  a  young  lady 
sixteen  years  of  age, 
and  when  she  pre- 
sented the  right  su- 
perior central  incisor 
was  the  only  one  of 
the  superior  incisors 
that  occluded  w  i  t  h 
the  lower. 

Fig.  1  /  4  represents  Lack  of  Posterior  occlusion.    (Willis.) 

the  case  before  treatment. 

"  There  was  a  space  of  a  quarter  of  an  inch  between  the 
upper  and  lower  bicuspids  and  molars  when  her  jaws  were 
closed. 

"  A  Coffin  split-plate,  with  piano-wire  spring,  was  made  to 
spread  the  upper  bicuspids  and  molars.  This  was  worn  for 
six    weeks,  at  the   end  of  which  time   the   bicuspids   and 


"^Dental  Cosmos,  VoL  XXXVII.,  pp.  584-5. 


208  ORTHODONTIA. 

molars  were  directly  over  the  corresponding  teeth  of  the 
lower  jaw,  the  arch  having  been  widened  about  a  c[uarter  of 
an  inch. 

"  As  the  cuspids  originally  occupied  about  their  right 
positions,  the  next  step  was  to  move  forward  the  central  and 
lateral  incisors." 

After  describing  how  this  was  done,  the  article  continues : — 
"  The  lower  molars  and  bicuspids  were  badly  broken 
down  from  decay,  some  of  them  having  been  filled  half  a 
dozen  times.  To  put  them  in  good  condition  and  raise  their 
grinding-surfaces  to  articulate  with  the  upper  teeth,  they 
were  crowned. 

"  In  order  to  avoid  too  great  a  display  of  gold  on  the  first 
bicuspids,  a  new  method  was  resorted  to  in  crowning  them. 
A  gold  band  was  fitted  around  the  tooth,  extending  about  a 
sixteenth  of  an  inch  above  the  end  of  the  tooth.  An 
impression  and  bite  were  taken  at  the  same  time  by  covering 
the  tooth  and  band  with  plaster,  and  closing  the  jaws  while 
the  plaster  was  soft.  The  band  and  plaster  were  removed 
Fig.  175.  intact,  and  Mellotte's  fusible  metal  poured  into 
the  band.  The  crown  was  placed  on  the 
articulator,  and  a  bite  completed  with  Mellotte's 
metal  and  plaster.  The  plaster  was  now  removed 
from  the  band,  leaving  a  metallic  surface  one- 

A.  Porcelain  Tip.  sixteenth  of  an  inch  below  the  top  of  the  band 

B.  Gold  Band.       -^^^^  wliicli  to  fit  a  porcclaiii  top  for  the  crown. 
"  In  this  case  an  ordinary  plain  tooth,  such  as  is  used  in 

vulcanite  work,  \vas  selected  and  ground  to  fit  into  the  gold 
band  and  of  the  right  length  to  articulate  with  the  upper 
teeth.  This  porcelain  tip  was  cemented  into  the  gold  band, 
and  the  whole  removed  from  the  articulator.  The  fusible 
metal  was  heated  a  little,  and  readily  came  away  from  the 
crown. 

Fig.  175  represents  the  completed  crown  before  the,  two 
portions  were  joined  together. 

"  These  crowns  were  cemented  over  the  natural  teeth  and 


LACK    OF    POSTERIOR    OCCLUSION.  209 

produced  a  nice  appearance  as  nothing  but  the  porcelain 
showed  when  the  mouth  was  opened,  tlie  Up  and  tongue 
entirely  hiding  the  gold  band. 

"  A  crown  of  this  description  is  particularly  adapted  for 
the  lower    molars  yig.  176. 

and  bicuspids,  es- 
pecially when  they 
need  to  be  brought 
up  some  distance 
above  the  natural 
tooth. 

Fig.  176  repre- 
sents the  case  after 
correction. 

"  A     very    small  corrected  Case. 

vulcanite  retaining  plate  was  worn  to  hold  the  upper  teeth 
in  position." 

Lack  of  Lateral  Occlusion. — This  form  of  irregularity  is 
usually  confined  to  one  side  of  the  arch  and  is  generally 
caused  by  late  eruption  of  the  bicuspids  after  their  allotted 
space  has  been  encroached  upon  by  the  adjoining  teeth 
to  such  an  extent  as  to  prevent  their  full  eruption. 

If  the  extraction  of  some  tooth  to  make  room  is  not 
deemed  advisable,  forcible  extrusion  must  be  resorted  to. 

One  way  of  accomplishing  this  in  a  case  involving  both 
sides  of  the  arch  is  described  and  illustrated  by  Dr. 
Davenport.*  The  patient  was  a  young  lady  whose  superior 
anterior  teeth  protruded  abnormally. 

In  reducing  the  deformity  by  retracting  the  superior 
incisors  the  occlu.sion  of  the  anterior  teeth  prevented  the  side 
teeth  from  coming  into  contact.  To  elevate  the  latter  he 
constructed  a  bridge  appliance  of  gold  consisting  of  caj)s  for 
the  molars,  a  saddle  for  the  six  anterior  teeth  and  a  frame 
work  connecting  the  two.  The  whole  device  was  so  shaped 
as  to  furnish  a  suitable  masticating  surface  for  the  upper 


*  Dental  Review,  Feb.,  "96. 


210 


ORTHODONTIA. 


Fig.  177. 


teeth.     The  short  bicuspids  and  molars  were  then  hgated  to 
this  bridge  and  thus  drawn  gradually  to  a  proper  height. 

The  appli- 
ance in  posi- 
tion is  shown 
in  Fig.  177. 

A  n  0 1  h  e  r 
case  of  lack 
of  lateral  oc- 
clusion, i  n  - 
volving  only 
the  bicusjDids 
on  one  side 
of  the  mouth, 
is  reported 
by  Prof.  God- 
da  rd.* 

Fig.  178 
represents 

the  case  before  and  after  correction,  together  with  the  appli- 
ances used. 

The  writer  says  : — "  Bands  with  hooks  are  attached  to  lioth 

upper  a  n  d 
lower  teeth 
and  a  rubber 
ring  stretched 
from  each 
upper  hook 
to  the  cor- 
responding 

Lack  of  Lateral  Occlusion.    (Goddard.)  loWCT  OllC    Or 

the  23lace  of  either  upper  or  lower  band  may  be  supplied  by 
a  ligature. 

"  The  patient  should  unhook  each  ring  while  eating,  and 
readjust  it  afterward." 


Appliance  lor  Extnisiou.    (.Davenport. 


Fig.  178. 


The  American  Text  Book  of  Openitive  Dentistry,  p.  597. 


CHAPTER  X. 

INTRUSION    AND    EXTRUSION. 

The  term  Intrusion,  in  ortliodon'tia,  denotes  tlie  act  of 
thrusting  or  pushing  a  tooth  deeper  into  its  alveolus,  while 
Extrusion  signifies  the  pushing  or  drawing  of  a  tooth  partly 
out  of  its  socket.  The  two  movements  are  therefore  exactly 
opposite  in  character. 

Intrusion. — Normally,  each  tooth  will  advance  in  the  course 
of  its  eruption  until  the  whole  of  its  crown  projects  beyond  the 
free  margin  of  the  gum,  and  its  cutting  edge  or  masticating 
surface  is  in  proper  relation  with  the  same  surfaces  of  the 
adjoining  teeth.  Full  eruption  may  be  delayed  or  entirely 
prevented,  but  extra  elongation  will  not  occur  except  through 
accidental  circumstances.  When  it  does  occur,  it  is  usually 
the  result  of  an  abnormal  condition  of  the  pericementum, 
due  to  irritation  in  some  form,  or  it  is  caused  by  lack  of 
occlusion  with  teeth  in  the  opposite  jaw.  In  the  latter  case, 
it  is  but  the  manifestation  of  nature's  attempt  to  rid  the 
system  of  a  useless  organ. 

Extrusion  of  one  or  more  of  the  teeth  sometimes  occurs  in 
connection  with  regulating  and  is  due  either  to  the  irrita- 
tion of  the.  soft  tissues  surrounding  the  tooth  caused  by  the 
impingement  of  the  regulating  appliance  upon  them,  or  to 
the  unfortunate  application  of  power  in  such  manner  as  to 
favor  the  lifting  of  the  tooth  from  its  socket. 

When  such  extrusion  is  noticed  it  becomes  necessary  to 
remove  the  cause  and  give  rest  to  the  affected  parts.  The 
elongation  being  due  in  the  first  instance  to  the  temporary 
thickening  of  the  peridental  membrane  through  irritation, 
a  period  of  rest  will  usually  result  in  the  subsidence  of  the 
trouble  and  the  return  of  the  tooth  to  its  former  position. 

211 


212 


ORTHODONTIA. 


Fig.  179. 


Herbst,  Method  of  Intrusion. 


Fig.    180. 


AVhere  the  extrusion  is  the  result  of  misdirection  of  power 
the  operation  will  have  to  be  suspended  for  a  time,  to  be 
followed  by  the  use  of  more  suitable  appliances.  Should  the 
condition,  however,  be  allowed  to  continue  for  any  length  of 
time,  as  through  non-appearance  of  the  patient,  some  pres- 
sure may  have  to  be  applied  to  force  the  tooth  back  into  its 
socket.  This  may  be  accomplished  in  a  variety  of  ways.  A 
simple  plan  has  been  suggested  by 
Dr.  Wilhelm  Herbst. 

It  consists  in  cutting  a  short  and 
narrow  strip  from  a  piece  of  rubber 
dam  and  perforating  it  in  such  man- 
ner that  when  in  position,  the  crowns 
of  two  teeth  on  either  side  of  the  one 
affected  will  protrude  through  the 
openings,  while  the  extruded  tooth 
will  be  partly  covered  and  pressed 
upon  by  the  intervening  portion  of 
the  rubber.  Figs.  179  and  180  rep- 
strip    of    rubber   separately   and    in    position. 

Another  way  of  pro- 
ducing tension  upon 
t  h  e  el  ongated  tooth 
is  by  means  of  a  rubber 
plate  with  a  strip  of  gold 
so  attached  as  to  rest 
and  press  upon  the  cut- 
ting edge  of  the  tooth. 
A  far  better  method  is  the  one  adopted  by  Prof.  Goddard,* 
and  shown  in  Figs.  181  and  182. 

It  consists  in  banding  a  tooth  on  each  side  of  the  one  to 
be  operated  upon  and  connecting  the  bands  by  wires  sol- 
dered to  both  their  labial  and  lingual  surfaces ;  or,  as  shown 
in  cut  182,  soldering  the  wires  to  but  one  of  the  bands,  and 


Eubber  Strip  Applied. 


resent    the 


Fig.  181. 


Device  for  Intrusion.    (Goddard.) 


"  The  American  Text-Book  of  Operative  Dentistry,  p.  594. 


INTRUSION.  21.5 

allowing  their  free  ends  to  rest  upon  hooks  attached  to  the 
other  band.  AVhen  in  place,  a  slender  rubber  ring  is 
stretched  from  one  wire  to  the  other,  passing  in  its  course 
over  the  incisal  edge  of  the  extruded  tooth.  A  small  cap 
with  a  notch  in  it  should  be  cemented  to  the  long  tooth  to 
keep  the  rubber  in  position.  Fig.  182. 

Fig.  182  shows  the  method  of  con-        .^^^^^^^  r*^ 
struction.  <{}  W^ 

Dr.  Ottolengui  describes  and  illus-     \^^  "'  ~ 
trates  his  method  of  retracting  and         Detail  of  coostraction. 
intruding  two  central  incisors  at  the  same  time.* 

He  savs  : — "  In  this  instance  the  patient  was  but  nine 
years  of  age,  and  it  was  necessary,  as  a  primary  step  in  the 
correction,  to  retract  the  two  central  incisors.  A  cap  of 
pure  gold  was  constructed  by  swaging,  and  this,  having  a 
wire  soldered  across  the  labial  surfaces,  forming  two  loops, 
was  then  cemented  to  the  two  teeth.  Continuous  caps  for 
the  molars  (both  temporary  molars  on  each  side  being  still 
in  place)  were  then  made  in  the  usual  manner,  except  that 
the    metal    was    ex-  yig.  183. 

tended  to  cover  the  j 

gum  at  the  buccal  as-  "     -  \ 

pect,  extending  high 
up  under  the  lip  op- 
posite the  site  of  the 
first  bicuspids  (had 
they    been    present). 

The      UDDer     ed^e    of  Retraction  and  Intrusion.    (Ottolengui.) 

this  plate  was  made  rigid  and  comfortable  by  soldering  a 
wire  along  the  edge.  At  the  highest  point  in  the  bicuspid 
region  a  hook  was  fashioned  and  another  opposite  the  molar.. 
These  caps  were  also  held  in  place  with  cement.  At  the 
outset  the  rubber  ligatures  were  attached,  stretching  from 
the  corners  of  the  incisors  to  the  first  and  highest  hooks  on 

*  Items  of  Interest,  July  '97,  p.  511. 


214 


ORTHODONTIA. 


Fig.  184. 


the  back  pieces.  Later,  as  more  pressure  became  endurable, 
the  Hgatures  passed  over  these  hooks,  and  back  to  the  hooks 

opposite  the  molars.  In 
either  arrangement  the 
ligatures  exert  pressure 
upward  as  well  as  back- 
ward. 

Figure  183  shown  the 
buccal  aspect  of  the  appa- 
ratus, with  the  ligature  in 
position.  Figure  184  shows 
the  roof  of  the  mouth,  and 
the  general  shaj^e  of  the 
various  pieces  cemented 
to  the  teeth." 

Retraction  and  Intrusion.    (Ottolengui.)  A ,-,       ino'enioUS      dcvicC 

designed  by  Prof.  Case  *  for  the  double  purpose  of  intrud- 
ing the  incisors  and  extruding  the  bicuspids,  is  shown  in 
Fig.  185. 

In  describing 
its  construction 
he  says : — "  On 
each  molar  (first 
or  second  ac- 
cording to  the 
age  of  the  pa- 
tient) is  placed 
a  hollow  metal 
crown     on    the 

Intrusion  and  Extrusion.    (Case.)  buCCal       SUrfaCC 

of  which  is  soldered  an  open  tube  or  trough,  opening 
upward.  On  each  l^icuspid  is  cemented  a  band  with  a 
buccal  hook  pointing  downward,  also  on  the  first  molar  if 
the  second  has  been  used  for  supporting  the  hollow  crown. 


Fig.  185. 


*  Dental  Review,  Dec.  '95. 


EXTRUSIOX.  215 

On  the  incisors  are  cemented  bands  with  hooks  turned 
upward.  A  labial  bow  of  elastic  German  silver  or  piano- 
wire  Jias  its  ends  inserted  in  the  troughs  of  the  hollow 
crowns,  its  front  resting  above  the  hooks  on  the  incisors,  and 
its  sides  pressed  under  the  hooks  on  the  bicuspids  and  first 
molar.  The  action  is  such  as  to  depress  the  incisors  and 
elevate  the  bicuspids,  and,  if  possible,  the  first  molars  also." 

Extrusion. — Incisor  teeth  which  have  not  erupted  to  their 
full  extent  and  have  been  prevented  from  doing  so  by  the  too 
close  proximity  of  adjoining  teeth  or  other  cause,  may  often  be 
assisted  in  assuming  their  proj)er  alignment.  Where  space 
exists,  teeth  will  naturally  accomplish  their  full  eruption 
unaided,  as  previously  stated.  When  they  do  not,  and  there 
is  no  visible  cause  for  their  not  doing  so,  we  may  safely  infer 
that  some  hindrance  exists  in  the  tissues  beneath  the  gum. 
It  may  only  be  an  unexplainable  suspension  of  the  act  of 
eruption,  or  it  may  be,  and  often  is,  a  curvature  or  enlarge- 
ment of  the  root  that  prevents  the  further  progress  of  the 
tooth.  Which  of  the  two  it  is,  can  usually  only  be  decided 
after  measures  of  assistance  have  been  tried. 

If  the  delayed  eruption  has  been  due  simply  to  a  suspen- 
sion of  the  act  of  eruption,  the  simplest  and  most  effective 
remedy  Avill  be  found  in  tying  a  silk  ligature  around  the 
neck  of  the  tooth  and  pressing  it  well  under  the  free  margin 
of  the  gum,  or  in  placing  a  ring  cut  from  rubber  tubing  in 
the  same  position.  Either  one  will  cause  irritation  of  the 
j)ericementum,  which  by  consequent  enlargement  will  tend 
to  force  the  tooth  out  of  its  socket.  To  prevent  undue  elon- 
gation the  case  will  have  to  be  carefully  watched,  day  by 
day,  and  the  irritating  ligature  removed  as  soon  as  the  tooth 
has  been  sufficiently  elongated.  If  this  be  neglected,  the 
tooth  may  be  entirely  expelled  and  lost. 

Should  these  simple  means  fail  to  move  the  tooth  from  its 
abnormal  position,  osseous  abnormality  is  probably  the  hin- 
dering cause,  and  mechanical  appliances  of  not  too  great 


216 


ORTHODONTIA. 


power  should  be  tried.     Some  of  this  character  have  ah^eady 
been  mentioned. 

Where  full  eruption  of  a  tooth  has  been  made  impossible 
by  the  impingement  of  adjoining  teeth  upon  the^space 
intended  for  it,  increase  of  space  by  lateral  pressure  uj^on  the 
interfering  teeth  should  first  be  gained  before  any  attempt 
is  made  at  elongation.  Indeed,  the  mere  enlargement  of 
the  space  and  its  retention  for  a  length  of  time  will  usually 
be  followed  by  the  unaided  eruption  of  the  tooth.  Should 
this  not  occur  mechanical  assistance  will  have  to  be  ren- 
dered by  some  method. 

Fig.  186.  Prof.  Goddard  produces 

extrusion  of  an  incisor  by 
means  of  the  appliance 
shown  in  Fig.  186. 

It    consists   of    i^artial 
caps  of  gold  fitted  to  the 
two  adjoining  teeth  and 
connected  by  a  wire  sol- 
dered to  them.     Tlie  par- 
tially erupted  tooth  has  a  Magill  band  cemented  to  it,  and 
on  the  central  portion  of  this  band  on  both  labial  and  lin- 
gual sides  is  soldered  a  hook  or  pin.      After  the  connected 
^  caps  are  cemented  in  place 

a    rubber    ring  is  caught 
^_  ^^^^tma^  Q^g^,  Q^-^g  hook,  passed  over 

the  yoke,  and  caught  on 
the  other  hook. 

Fig.  187  shows  the  au- 
thor's method  of  produc- 
ing extrusion.  The  pa- 
tient, a  boy,  had  broken  off  the  mesio-incisal  corner  of  his 
superior  left  central.  Instead  of  trying  to  restore  the  broken 
portion  by  filling,  it  was  decided  to  draw  the  tooth  down 
and  grind  off  the  incisal  edge. 


Extrusion.    (Goddard.) 


Author's  Appliance  for  Extrusion 


EXTRUSION.  217 

To  do  this,  a  Magill  band  was  snugly  fitted  to  the  right 
central,  and  a  corresponding  band  (but  larger  than  the 
tooth)  was  soldered  to  it  at  its  periphery  to  surround  the 
left  central.  A  smaller  Magill  band  was  fitted  to  the  broken 
tooth  and  cemented  in  position  close  up  to  the  gum.  Each 
of  the  bands  surrounding  the  left  central  had  a  headed 
tooth-pin  soldered  to  its  central  portion.  After  cementing 
the  single  band  in  place,  the  double  band  was  cemented  to 
the  right  central  leaving  the  other  portion  of  it  free  to  pass 
over  the  left  central  with  a  space  between  the  band  and  the 
tooth. 

The  pins  on  the  two  bands  were  now  connected  by  means 
of  platinum  binding  wire  with  the  ends  twisted  together. 
Tightening  the  twist  at  intervals  of  a  few  days  soon 
brought  the  tooth  down  below  its  fellows,  when  the  pro- 
jecting broken  edge  was  dressed  to  a  proper  line  with  a 
corundum  wheel. 

After  the  operation  was  completed,  the  appliance  was 
kept  in  place  for  a  month  as  a  retainer.  The  virtue  of  this 
appliance  consisted  in  its  not  interfering  with  mastication 
and  in  its  simplicity  and  inconspicuousness. 

Forcible  eruption  of  a  tooth  by  means  of  the  extracting 
forceps  is  seldom  justifiable,  for  we  cannot  always  know 
what  may  have  interfered  with  the  eruption.  In  certain 
exceptional  cases,  where  a  careful  examination  reveals  no 
sign  of  malformation  of  the  root  and  where  it  is  perfectly 
evident  that  slight  impingement  of  adjoining  teeth  has  been 
the  sole  hindrance  to  full  eruption,  the  forceps  may  prove  a 
valuable  means  of  effecting  a  rapid  and  easy  correction  of 
the  difficulty. 

Such  a  case  occurred  in  the  author's  practice.  The  patient 
was  a  gentleman  of  about  twenty-eight  years  of  age,  whose 
right  central  incisor  was  about  a  line  shorter  than  its  mate. 
It  had  been  tardy  in  erupting  and  in  consequence  there 
was  a  slight  lack  of  space  for  its  accommodation,  as  shown 
in  Fig.  188. 


218  ORTHODONTIA. 

As  the  difference  in  length  of  the  two  incisors  was  too' 
great  to  be  remedied  by  the  simple  means  of  reducing  the 
length  of  the  longer  one,  it  was  decided  to  elongate  the 
shorter  one.  A  careful  examination  proving  favorable,  a 
piece  of  sand  paper  was  folded  so  as  to  cover  both  labial 
and  lingual  surfaces  of  the  tooth  to  protect  it  from  injury, 
after  which  it  was  grasped  with  the  forceps  and  by  a  com- 
bined rotary  and  downward  motion  brought  into  place. 
Once  in  position,  it  was  held  there  firmly  by  the  pressure 
.  p       ^gg  of  the   adjoining  teeth,  but  as 

good  judgment  would  not  sanc- 
tion so  unreliable   a  means  of 
retention,  an  appliance  had  to 
be  devised  that  would  not  only 
Incomplete  Eruption.^         prcveiit  the  tooth  from  slipping 
back   into   its   socket   but  also 
secure  it  from  being  forced  forward   by  pressure  upon  its 
sides.    The  patient  also  desired  the  apjDliance  to  be  as  incon- 
spicuous as  possible. 

To  accomplish  all  of  these  ends,  a  piece  of  platinous  gold 
wire,  a  little  thicker  than  a  vulcanite  tooth-pin,  was  bent 
into  horseshoe  form  and  curved  to  conform  to  the  lingual 
surfaces  of  the  retarded  tooth  and  the  two  adjoining  ones. 
The  ends  of  the  wire  were  then  flattened  and  bent  so  that 
they  would  hook  over  and  rest  upon  the  incisal  edges  of 
the  adjoining  central  and  lateral.  A  silk  ligature  was  passed 
around  the  moved  tooth  and  tied  in  front,  after  which  the 
ends  were  again  passed  to  the  lingual  surface  and  tied 
just  below  the  cingulum.  After  the  gold  wire  w^as  placed  in 
position,  the  ligature  was  attached  to  it  at  the  lower  point 
of  its  central  curve. 

The  ligature  thus  held  the  appliance  in  position  and  it  in 
turn  kept  the  tooth  from  receding.  The  double  arrange- 
ment of  wire  and  ligature  also  guarded  the  tooth  against 


EXTRUSION. 


219 


the  possibility  of  moving  forward.  The  fixture  in  jDosition 
is  shown  in  Fig.  189.  The  only  parts  of  it  visible  were  the 
small   rounded   gold  tips   that  ^ig  189 

overlajjpecl  the  incisal  edges  of 
the  two  adjacent  teeth. 

Where  sufficient  sj^ace  exists        ijy  ^^     ~  / 

for  the  purpose,  the  tooth  after 

being  drawn   into  position  may  Retention  after  correction. 

be  held  by  means  of  the  platinum  band  and  extension  bar, 
as  shown  elsewhere  for  retaining  a  tooth  that  has  been 
forced  backward  into  the  line  of  the  arch. 


CHAPTER  XI. 

SUEGICAL  CORRECTION. 

The  correction  of  irregularity  of  the  teeth  by  surgical 
methods  has  been,  as  yet,  but  little  attempted  owing  to  its 
limited  applicability  and  its  seeming  violence.  The  more 
conservative  method  of  slow  movement  has  continued  to 
prevail  because  it  accomj)lished  its  object  and  was  not  likely 
to  be  accompanied  by  any  ill-results. 

In  these  days,  however,  when  minor  surgery  is  being 
more  resorted  to  by  the  dental  practitioner  in  the  treatment 
of  antral  disease,  root  amputation  and  the  implantation  of 
teeth,  there  would  .appear  to  be  no  good  reason  why  the 
practitioner  in  the  line  of  orthodontia  should  not  avail 
himself  of  the  benefits  to  be  derived  from  surgical  procedure. 

The  teeth  being  strong  and  hard  bodies  are  not  liable  to 
fracture;  the  investing  perecimentum  is  a  membrane  of 
great  vitality  and  strong  recuperative  powders ;  the  cancel- 
late  tissue  of  the  alveolar  process  is  open  and  readily  broken 
down  and  the  cortical  layer  in  certain  localities  is  thin  and 
elastic.  The  only  source  of  danger  in  rapid  and  foieible 
movement  of  the  teeth  lies  in  the  liability  of  devitalizhig 
the  pulp  which  is  a  delicate  organ  and  readily  injured. 
This  liability  can,  however,  be  reduced  to  a  mini'/"„.m  by 
proper  precaution  and  a  judicious  selection  of  cases  to  be 
operated  upon. 

It  seems  safe  to  predict  that  when  the  possibilities  of  luxa- 
tion are  more  fully  appreciated  and  the  methods  for  its 
proper  performance  have  been  more  perfectly  developed  it 
will,  in  a  limited  class  of  operations,  largely  supjDlant  the 
slower  methods  which  have  so  long  prevailed.  The  first 
recorded  efforts  at  forcible  movement  of  teeth  are  those  of 

220 


SURGICAL    CORRECTION.  221 

Sir  John  Tomes.*  He  confined  the  operation  to  rotation  of 
teeth  in  their  alveoli  in  young  subjects  before  the  osseous 
tissues  had  become  fully  calcified.  He  reported  success  in 
nearly  every  case  operated  upon.  Since  then  the  same 
operation  has  been  successfully  performed  by  numbers  of 
practitioners  with  very  general  success. 

The  practice  has  to  be  confined,  of  course,  to  single-rooted 
teeth  with  nearly  round  and  straight  roots.  The  difficulty 
of  determining  whether  a  concealed  root  is  straight  or 
curved,  renders  the  oj)eration  a  somewhat  hazardous  one, 
for  with  a  curved  root  there  is  danger  of  fracture.  In  per- 
forming the  operation,  a  forceps  should  be  selected  whose 
beaks  nearly  fit  the  tooth  at  its  neck  and  to  prevent  slipping 
and  guard  against  injury  to  the  enamel,  a  piece  of  heavy 
sand-paper  (with  the  sanded  surface  next  to  the  tooth) 
should  be  laid  entirely  over  the  crown  before  it  is  grasped 
by  the  forceps.  When  it  is  seized,  rotary  motion  should  be 
made  back  and  forth  until  the  tooth  is  loosened,  after  which 
it  should  be  steadily  turned  in  the  desired  direction  until  it 
reaches  its  proper  position.  It  may  be  retained  either  by 
silk  or  wire  ligatures,  or  preferably  by  a  metal  cap  or  splint 
(previously  formed)  cemented  to  it  and  an  adjoining  tooth 
on  each  side.  The  tooth  will  usually  become  firm  in  the 
course  of  ten  days  or  two  weeks. 

The  next  contribution  to  the  subject  was  a  paper  read 
before  the  American  Dental  Society  of  Europe,  at  Basel,  by 
Dr.  L.  C.  Bryan,  in  August,  1892. f  In  his  paper.  Dr.  Bryan 
relates  his  method  of  surgical  correction  as  follows  : 

"The  treatment  which  I  have  finally  adopted  is  to  inject 
cocaine  and  either  partially  cut  away  the  thick  intervening 
alveolus  with  drills  and  long  fissure-burs,  or,  when  the 
alveolus  is  thin,  bodily  wedge  the  outer  alveolar  wall  away 
with  a  half  round,  wedge-shaped  chisel,  by  inserting  the 
point  of  the  instrument  between  the  tooth  crown  and  the 

*Dental  Surgery,  2nd  ed.,  p.  162. 
-\Dental  Reviexo,  Vol.  VI.,  p.  858,  et  seq. 


222 


ORTHODONTIA. 


bone,  and  forcing  it  up  along  the  root  until  enough  space  is 
secured  for  the  tooth  to  be  brought  out  into  place  outside  of 
the  lower  tooth. 

"  This  latter  I  formerly  accomplished  by  pressing  the  above 
wedge-shaped  instrument  or  the  inner  beak  of  a  suitably 
formed  forceps  up  along  the  palatal  surface  of  the  tooth  until 
the  crown  was  forced  outward  sufficiently  to  be  firmly  grasped. 
It  was  then  brought  gradually  out  into  place,  and  secured 
with  a  small   plate,  or  ligatures.     My   present   method  of 

Fig.  190. 


Forceps  and  Fulcrum  for  Tooth  Luxation.    (Bryan.) 


operating  is  much  simplified  by  the  forceps  and  fulcrum 
which  are  herewith  presented. 

"As  you  will  see  it  has  lobster-claw  jaws  or  perhaps  it 
more  resembles  the  Tapir's  jaws  with  round  drooping  pro- 
boscis and  the  short  receding  lower  jaw.  This  long,  serrated 
jaw  rests  upon  a  fulcrum  fitted  to  the  arch  of  the  maxilla  to 
be  operated  upon,  and  the  short  beak  pushes  against  the 
palatal  aspect  of  the  tooth  to  be  brought  out  into  line. 

"  I  consider  it  absolutely  necessary  to  lift  the  outer  alve- 


SURGICAL    CORRECTION.  223 

olar  plate  before  attempting  regulation  on  account  of  the 
great  danger  of  accident  to  the  pulp  if  the  alveolar  margin 
including  the  solid  septa  between  the  teeth  are  not  broken  up. 

"  By  the  injection  of  cocaine,  or  the  application  to  the 
gum  of  calorific  fluid,  the  pain  of  drilling,  or  breaking  away 
the  bone,  can  better  be  borne  by  highly  sensitive  or  nervous 
patients  than  the  continued  pain  of  regulating  pressure,  and 
consequent  systemic  disturbance  from  inflammation  and 
broken  rest.  When  general  anaesthesia  can  be  resorted  to, 
the  work  can  be  done  more  thoroughly  and  carefully." 

In  1893,  Dr.  Geo.  Cunningham  of  England,  read  a  paper 
at  the  World's  Columbian  Dental  Congress,*  entitled  "  Luxa- 
tion, or  the  Immediate  Method,  in  the  Treatment  of  Irregu- 
lar Teeth,"  in  which  he  reported  a  number  of  cases  operated 
upon  by  him  surgically  for  irregularity.  The  operations 
were  much  more  extensive  in  character  than  those  per- 
formed by  Dr.  Bryan  or  anyone  previously,  and  while  all 
were  not  successful  the  majority  of  them  were.  His  practice 
in  this  line  had  extended  over  some  seven  years,  and  his 
experience  warranted  him  in  continuing  it.  His  method  of 
procedure  did  not  differ  in  any  essential  particulars  from 
that  of  Dr.  Bryan,  except  that  in  extensive  operations  he 
administered  a  general  instead  of  a  local  angesthetic. 

Dr.  Talbot's  method  f  differs  from  those  of  his  predecessors 
in  that  he  combines  both  surgical  and  mechanical  means  in 
accomplishing  his  object,  and  throws  around  them  the  safe- 
guard of  aseptic  treatment.  He  claims  for  his  method  that 
it  is  very  advantageous  where  dense  tissue  needs  to  be 
removed,  and  in  cases  where  it  is  difficult  to  obtain  sufficient 
anchorage  inside  of  the  mouth.  By  thus  removing  the  chief 
obstruction  to  tooth-movement,  teeth  may  be  moved  by 
depending  upon  an  anchorage  which,  in  ordinary  cases, 
would  be  entirely  inadequate.  He  describes  his  method  as 
follows  : 

*  Transactions,  Vol.  I.,  p. 

tDental  Cosmos,  Vol.  XXXVIII.,  p.  909. 


224 


ORTHODONTIA. 


Fig.  191. 


"  My  method  consists  in  removing  the  alveolar  process  in 
the  line  of  travel  of  the  tooth  to  be  moved,  leaving  a  small 
amount  about  the  root  of  the  tooth  to  hold  intact  the  peri- 

dental  membrane. 
This  is  accomplished 
with  coarse-cut  Reve- 
lation burs,  or  those 
that  will  cut  in  all  di- 
rections. 

"If  a  cuspid  requires 
to  be  carried  back- 
ward, make  an  appli- 
ance with  bands  about 
the  first  and  second 
molars,  with  cap  upon 
the  cuspids  and  a  bar 
with  screw  and  nut 
,  upon  the  end,  as  recom- 

^y  mended   by   Dr.    Far- 

Surgical  and  Mechanical  Correction.    (Talbot.)       j,^p        Extract    the  first 

bicuspid  and  then  resting  the  hand  against  the  cuspid,  cut 

out  the  palatine  and 
buccal  V-shaped  plate 
with  a  bur,  m a k - 
ins  a  concave  surface  of 
the  alveolar  process,  as 
illustrated  in  Fig.  191. 

If  the  superior  inci- 
sors are  to  be  carried 
back,  cut  semi-circular 
spaces  just  posterior  to 
the  teeth  to  be  moved 
as  shown  in  Fig.  192. 

"  To  move  into  line 
a  cuspid  which  is  erupt- 
ing in  the  vault  of  the 


Fig.  192. 


Resection  Previous  to  Inward 
Movement.    (Talbot.) 


SURGICAL    COERECTIOX. 


225 


Fig.    193. 


mouth,  remove  the  alveolar  process  in  the  direction  of  the 
line  of  travel  as  in  Fig.  193. 

In  moving  teeth  laterally  by  a  jack-screw,  it  will  not  infre- 
quenth^  be  found  that 
one  tooth  moves 
faster  than  the  other. 
To  bring  both  to 
their  proper  positions 
cut  out  the  alveolar 
process  on  the  side  of 
the  slower  moving 
tooth,  and  both  will 
come  into  |)roj)er 
position,  see  Fig.  194. 

"  In    this    manner 
teeth  not  only   may 
be  moved   very  rap- 
idly   and     without 
much  pain,  but  we  have 
the   tooth    or  teeth   to  be 
moved   completely   under 
control.     Any  of  the  teeth 
in  the  mouth  may  be  used 
for  the  fixed   point  of  re- 
sistance, thus  doing  away 
with  all  unsightly   appli- 
ances     outside      of     the 
mouth. 

"  When    in    place     the 
teeth  should  be  anchored 

in      the      usual      manner.  to  Assist  cuspid  Movement.    (Talbot.) 

Antiseptic  washes  should  also  be  used  from  time  to  time, 
such  as  one  per  cent,  corrosive  sublimate,  listerine,  or  five 
per  cent,  carbolic  acid. 


Path  Prepared  for  Cuspid.    (Talbot. 


Fig.  194. 


CHAPTER  XII. 

MISCELLANEOUS. 

Crowded  Lower  Incisors. — While  general  consideration  has 
been  given  to  teeth  erupting  or  situated  inside  or  outside  of 
the  arch,  there  is  one  condition  of  rather  common  occur- 
rence that  calls  for  special  mention.  It  is  the  crowded  or 
jumbled  condition  of  the  inferior  incisors  after  dentition  is 
complete. 

Fig.  195  shows  an  extreme  case  of  this  character. 

The  moving  of  a  single  lower  incisor  either  inward  or 
outward  into  line  has  been  treated  of  in  Part  III.,  Chapters 
I.  and  II.,  but  where  several  or  all  of  these  teeth  are  more  or 

Fig.  195.  ^^^^  *^^^  *^f  li^®  ^^^^  possibly 

turned  upon  their  axes,  the 
condition  becomes  a  some- 
what difficult  one  to  treat 
successfully. 

The  expanding  of  the  arch 
to  permit  of  all  of  them  be- 

Crowded  Lower  Incisors.  [-^g      brOUght      prOpcrly     iutO 

line  involves  an  operation  of  some  magnitude,  and  is  likely, 
in  many  cases,  to  disarrange  an  otherwise  good  occlusion. 
For  these  reasons  expansion  should  not  be  attempted  except 
in  very  rare  cases,  where  improvement  of  the  occlusion  is 
desired  and  can  be  attained. 

Two  simple  methods  of  treating  these  cases  are  open  to  us: — 
First,  where  the  crowding  is  not  excessive,  each  of  the 
malposed  teeth  may  be  dressed  off  at  the  most  prominent 
points  of  their  approximal  surfaces  by  means  of  hard  rubber 
and  corundum  disks  or  by  the  more  flexible  emery-cloth 
disks,  and  by  thus  lessening  their  respective  diameters 
proper  accommodation  may  be  found  for  them  in  the  arch. 

226 


CROWDED    LOWER    INCISORS. 


227 


Second,  where  the  teeth  are  very  much  crowded  out  of 
position  and  where  the  space  between  tlie  cuspids  is  entirely 
inadec[uate  for  their  accommodation  it  will  be  best  to 
extract  one  of  them  in  order  to  enable  the  remaining  three 
to  be  brought  into  place. 

As  mentioned  on  page  45,  the  best  tooth  to  extract  in  such 
cases  is  the  one  most  out  of  line,  or  the  one  in  such  position 
as  to  enable  the  remaining  ones  to  be  most  easily  moved 
into  proper  alignment. 

After  extraction,  means  will  have  to  be  adopted  to  draw 
the  teeth  into  position,  in  doing  which  the  space  created  by 
extraction    will  Fig    iqq 

also  be  closed. 
Perhaps  the 
simplest  way  of  ft  (/  J^^ 
drawing  the  |% 
teeth  together  is 
by  the  use  of  a 
rubber  ring 
slipped  over  the 
teeth  and  kept 
from  impinging 
upon  the  gum 
by  a  silk  liga- 
ture wound  SeV-  straightening  Lower  Incisors.    (Kingsley.) 

eral  times  around  the  terminal  teeth  near  their  necks  and 
then  tied  to  the  ring  itself. 

After  the  teeth  are  drawn  together  and  the  space  closed, 
they  may  be  aligned  by  any  of  the  apj^liances  illustrated 
for  moving  individual  incisors. 

Dr.  Kingsley  illustrates  and  describes  an  appliance  and 
method  for  drawing  the  lower  incisors  together  (after  one 
has  been  extracted)  and  moving  them  into  line  at  the  same 
time ;  Fig.  196.  He  says : — *  "  It  was  a  vulcanite  plate  Avith 
piano-wires,   one   from  each  side,  meeting  and  lapping  in 


^Dental  Cosmos,  VoL  XXXIV.,  p.  106. 


228 


ORTHODONTIA. 


Fig.   197. 


front,  and  in  their  relaxed  positions  standing  off  for  an 
eighth  of  an  inch  from  the  face  of  the  teeth,  but  were 
sprung  in  and  tied  to  the  incisors  with  waxed  Ugatures. 
This  vulcanite  plate  was  made  pretty  stout,  comparatively 
non-elastic,  and  impinged  upon  the  lingual  walls  of  the 
bicusjDids  and  molars,  for  the  purpose  of  assisting  nature, 
which  was  widening  the  arch  by  occlusion  with  the  upper 
one,  and,  as  from  time  to  time  it  loosened  by  those  teeth 
yielding,  the  plate  was  warmed  and  readjusted.  A  small 
ring  from  rubber  tubing  was  also  stretched  over  the  three 
teeth  to  assist  in  closing  the  gap.  In  four  weeks  the  space 
was  closed.  The  retaining  fixture  was  exactly  like  the 
regulating  plate  without  the  piano-wire  attachments." 

Another  retaining  appliance  for  cases  of  this  character 
occupying  but  little  space  and  holding  the  teeth  firm,  is  shown 

in  Fig.  197.  It  is  construct- 
ed by  fitting  metal  bands 
to  the  anchor  teeth  and  then 
taking  an  impression  of  these 
in  position,  together  with  the 
lingual  surfaces  of  the  inter- 
vening teeth.  A  model  of 
plaster  and  marble-dust, 
made  from  this  impression, 
will  enable  us  to  fit.  the  connecting  strip,  and  after  securing 
it  in  place  with  binding  wire,  solder  it  to  the  bands. 

Where  greater  accuracy  is  desired,  the  strip  may  be 
swaged  up  to  shape  by  dies  made  from  the  same  or  a  dupli- 
cate model. 

The  retainer  can  be  made  to  do  a  little  delicate  adjusting 
by  slightly  trimming  on  the  model  the  still  prominent 
corners  of  any  teeth  which  we  may  desire  to  move  outward. 
Tooth- Shaping. — During  the  act  of  regulating  or  after  its 
accomplishment,  one  of  the  most  useful  accessory  opera- 
tions, when  called  for,  is  that  of  dressing  or  shaping 
certain  teeth  so  as  still  further  to  improve  their  appearance. 


Author's  Retainer. 


TOOTH-SHAPING.  229 

This  operation  will  probably  not  be  necessary  in  the 
majority  of  cases  we  treat,  but  when  indicated  it  adds 
very  much  to  the  patient's  appearance  and  the  satisfaction 
of  the  parent  and  operator.  It  may  be  accomplished  by 
means  of  the  file,  corundum  wheel,  sand-paper  disk  or  emery- 
cloth  strips,  each  having  value  according  to  the  require- 
m.ents  of  the  case. 

It  will  not  often  be  called  for  on  the  approximal  surfaces 
of  teeth,  but  when  it  is,  much  of  the  substance  should  not 
be  removed  and  the  surface  should  afterward  be  polished 
in  the  most  perfect  manner. 

The  author  has  had  one  case,  and  one  only,  in  which  such 
trimming  of  approximal  surfaces  seemed  advisable.  The 
patient  was  a  young  lady  of  about  twenty-one  years  of  age, 
whose  anterior  superior  teeth  were  slightly  prominent.  The 
teeth  were  without  interdental  spaces  and  all  of  the  posterior 
ones  were  so  perfect  in  structure,  alignment  and  occlusion, 
that  the  extraction  of  even  one  of  them  would  have  been 
regarded  as  an  unwarranted  sacrifice. 

All  of  the  six  anterior  teeth  had  small  cavities  upon  each 
of  their  approximal  surfaces,  and  it  was  therefore  decided 
that  in  the  filling  of  these  cavities  a  slight  portion  of  each' 
approximal  surface  should  be  dressed  off  in  the  hope  that 
the  aggregate  of  such  spacing  would  be  sufficient  to  enable 
the  teeth  to  occupy  a  position  more  in  harmony  with  the 
normal  line  of  the  arch.  After  the  filling  and  dressing  of 
the  surfaces  the  teeth  were  drawn  inward  and  the  result 
was  all  that  could  have  been  desired. 

Sometimes  teeth  that  have  fully  erupted  out  of  line, 
when  brought  into  proper  position  extend  below  the  line  of 
the  occlusal  edges  of  their  neighbors  and  the  rest  of  the  teeth 
in  the  arch.  Any  attempt  to  reduce  their  elongation  by 
forcing  them  up  into  the  socket  would  not  only  be  extremely 
difficult;  but  in  many  cases  futile.  The  better  plan,  if  the 
disparity  in  length  be  not  great,  is  to  grind  off  their  occlusal 
edges  somewhat,  and  thus  accomplish  the  desired  end  in 
a  very  simple  manner. 


230 


ORTHODONTIA. 


Fig.  198. 


Fig.  199. 


Elongated  Centrals.    (How.) 


Fig.   200. 


Improvement  by  Grinding. 


Fig.    201. 


Fig.  198  shows  a  case  of  this  character,  and  Fig.  199  the 
improvement  after  grinding. 

Again,  teeth  out  of  hne  have  sometimes  from  lack  of 
attrition  preserved  their  normal,  rounded  form,  while  their 
fellows  have  more  or  less  been  worn  away  on  their  cutting 

edges     either 
through     ab- 
normal     oc- 
clusion    or 
excessive  use. 
When      the 
m  a  1  p  o  s  e  d 
teeth    have 
been  brought  into  posi- 
tion their  rounded  and 
unworn    edges   are  apt 
I  to      contrast     strongly 
with   the   abraded  sur- 

Unevenly  Worn  Incisors.    facCS  of  their  neighbors. 

°"'"  By  so  dressing  the  inci- 

sal  edges  of  the  unworn  teeth  as  to  resemble  those  next  to 
them,  greater  harmony  of  expression  will  result. 

Fig.  200  illustrates  a  case  in  which  the  worn  condition 
and  varying  length  of  the  lower  anterior  teeth  presented  a 
very   unsightly   appearance,   and   Fig.    201    represents  the 

improvement  made  by  re- 
ducing the  length  of  certain 
ones  and  straightening  the 
edges  of  others  by  grinding. 
Occasionally,  teeth  are  so 
abnormal   in   some  of  their 

Anomalous  Development.  QUtKneS    aS  tO  rCSCmblc   tcoth 

of  a  different  class,  or,  in  the  case  of  central  incisors,  they 
may  appear  to  have  changed  their  relative  positions: 

Fig.  202  represents  a  case  of  the  latter  kind,  from  the 
collection  of  Dr.  Eggleston.  In  all  such  cases  a  judicious 
use  of  the  corundum  wheel  will  cause  marked  improvement. 


After  Grinding. 


Fig.  202. 


MEDIAN    SEPARATION.  231 

Altering  the  form  of  a  tooth,  however,  may  often  be  made 
to  serve  even  a  more  useful  purpose  than  that  of  appearance. 
Cases  have  occurred  where  an  upper  tooth,  tardy  of  eruption, 
has  been  unable  to  come  entirely  down  into  line  owing  to 
the  meeting  of  its  antagonist  of  the  opposite  jaw  edge  to 
edge.  The  retarded  tooth  might  be  forced  sufficiently  out- 
ward to  enable  it  to  accomplish  its  full  eruption  and  then 
be  held  in  position  until  overlapping  had  taken  place,  but 
the  operation  may  be  advantageously  simplified  in  most 
cases  by  slightly  beveling  the  edge  or  cusp  of  the  lower 
tooth  on  its  labial,  and  the  upper  one  on  its  palatal  surface. 
The  inclined  plane  thus  formed  will  enable  the  upper  tooth 
to  slide  over  the  lower  one  into  line,  which  it  will  almost 
certainly  do  provided  there  be  no  obstruction. 

A  case  of  this  character  came  under  the  author's  notice 
recently  in  which  a  superior  lateral  incisor  was  thus  impeded 
in  eruption  until  the  individual  was  forty  years  of  age.  A 
simple  beveling  of  the  cutting  edges  of  it  and  its  opponent, 
induced  it  to  come  into  proper  line  within  a  year. 

Other  conditions  than  those  just  mentioned  will  occur  to 
the  practitioner  in  which  the  slight  alteration  of  the  form  of 
a  tooth  will  materially  assist,  or  be  the  means  of  entirely 
accomplishing  some  simple  act  of  regulating,  and  in  other 
cases,  greatly  add  to  the  effect  of  some  long-continued  and 
otherwise  successful  operation  in  orthodontia. 

Separation  in  the  Median  Line. — It  is  not  very  uncommon 
in  the  case  of  young  persons  to  find  the  superior  central 
incisors  standing  some  distance  apart  instead  of  being  in 
contact.  The  condition  may  be  caused  by  an  unusual 
thickening  of  the  median  septum,  or  by  the  late  eruption  of 
posterior  teeth  allowing  the  centrals  to  spread.  If  the  space 
be  not  great,,  it  will  often  become  obliterated  by  the  lateral 
pressure  of  the  cuspids  or  other  teeth  forcing  their  way  into 
position,  but  when  there  is  no  likelihood  of  this  occurring 
the  deformity  should  be  corrected  at  once.     If  permitted  to 


232  ORTHODONTIA. 

exist  it  may  interfere  with  distinct  enunciation  and  prove  a 
source  of  life-long  annoyance. 

Taken  early,  its  correction  is  easy  on  account  of  the  ready 
resorption  of  the  process.  So  simjDle  a  means  as  a  rubber 
band  slipped  over  the  two  centrals  will  often  close  the  space, 
but  it  will  in  turn  produce  spaces  between  the  centrals  and 
laterals. 

A  better  plan  is  to  employ  Magill  bands  with  a  screw  and 
nuts  as  shown  in  Fig.  80,  page  128,  except  that  the  nuts  in 
this  case  must  oiDerate  on  the  farther  sides  of  the  tubes. 
After  the  centrals  have  been  brought  together  by  this  means, 
the  laterals  can  be  drawn  up  close  to  them  by  rubber  bands 
caught  over  the  projecting  ends  of  the  screw  and  passing 
over  the  laterals.  The  rubber  band  over  the  left  lateral 
should  be  caught  over  the  screw-end  farthest  from  it  and 
the  right  lateral  treated  similarly.  When  corrected  the 
teeth  may  be  retained  by  thin  metal  bands  cemented  to  the 
laterals,  these  being  connected  on  their  labial  surfaces  by  a 
fine  wire  soldered  to  them.  Should  the  centrals  stand  far 
apart  and  be  perpendicular,  drawing  them  together  in  the 
usual  way  will  be  likely  to  cause  them  to  tip  toward 
one  another  in  an  unsightlj^  manner.  This  may  be  obviated 
by  placing  the  bands  and  screw  as  near  the  cervical  margin 
as  possible,  and  then  by  continuing  the  application  of  force 
after  the  incisal  edges'  are  in  contact,  the  power  of  the  screw 
will  compel  the  roots  to  move  toward  one  another  and 
recover  their  normal  positions. 

This  closing  of  the  space  in  the  median  line  by  the  moving 
of  the  four  incisors  will,  of  course,  create  some  space  between 
the  laterals  and  cuspids  on  each  side,  but  it  will  be  found  by 
the  time  the  retaining  fixture  needs  to  be  removed,  that  the 
posterior  teeth  have  moved  forward  and  pressed  the  cuspids 
into  contact  with  the  laterals. 


PART    IV. 

CHAPTER  I. 

CONSTRUCTION  OF  REGULATING  APPLIANCES. 

The  principal  tools  required  for  the  construction  of  metal 
regulating  appliances  are  illustrated  in  Plates  I.  and  II. 

"  a  "  is  the  ordinary  mouth  blow-pipe  to  be  used  in  con- 
nection with  a  large  alcohol  annealing-lamp  or  gas  Bunsen 
burner ;  "  6  "  is  the  best  form  of  jeweler's  pin-vise,  having 
pivoted  jaws  operated  by  an  inclined  plane  on  revolving- 
handle.  The  handle  is  bored  entirely  through  to  receive 
wire  of  any  length.  "  c  "  is  a  "  snip  "  plate  shears  such  as 
is  used  in  crown-  and  bridge-work.  "  d"  is  a  dental  pin- 
punch  and  "/"  a  solder  tweezers.  "  e"  is  known  as  a  clasp- 
bender,  and  with  its  one  beak  of  cylindrical  form  and  the 
other  concave  is  a  powerful  and  useful  instrument  for 
curving  and  shaping  piano  or  other  stiff  wire. 

"  g  "  and  "  h  "  are  respectively  fiat  and  round  nose  pliers, 
while  "  i  "  is  a  heavy  pliers  for  drawing  wire  or  tubing,  with 
notches  in  the  joint  for  cutting  wire,  "j  "  is  a  small  steel 
anvil  mounted  in  a  metal  base,  and  "7n"  is  a  jeweler's  saw- 
frame  and  saw.  The  figure  at  bottom  of  Plate  I.,  is  an 
adjustable  die-holder  and  die  with  two  taps  for  making 
screws  and  nuts.  "  o  "  is  a  pair  of  contouring  pliers,  while 
"  q "  and  "  r  "  are  metal  gauges.  "  q  "  is  the  Standard 
American  (B.  &  S.)  Gauge,  very  generally  used  for  both 
plate   and   wire.*     "r"   is   a    micrometer   gauge   for   more 


*  The  numbers  indicated  in  this  chapter  refer  to  the  B.  &  S.  gauge.  A 
comparative  table  of  the  various  gauge  measurements,  by  which  the  equiv- 
alent of  one  may  be  found  in  any  other,  is  appended  to  this  chapter. 

233 


234  ORTHODONTIA. 

delicate  and  accurate  measurements,  which  are  indicated  in  . 
thousandths  of  an  inch,     "s"  is  a  double-caUiper,  with  one 
end  for  inside  and  the  other  for  outside  measurement. 

"  t  "  is  a  seh-closing  tweezers  for  holding  parts  in  solder- 
ing, and  "  u  "  a  draw-plate,  known  as  the  "  Joubert,"  with 
thirty  different  sizes  of  holes.  The  illustrations  "  v  "  to  "  z  " 
will  be  referred  to  in  the  description  of  processes,  "aa" 
represents  a  metal  ferrule  or  band,  the  edges  being  drawn 
tight  and  held  together  with  fine  iron  binding-wire.  "  66," 
"  cc  "  and  "  dd  "  are  simple  forms  of  wire  clips  for  holding- 
parts  in  position  while  soldering.  They  are  made  from 
piano-wire,  Nos.  17  to  21,  each  about  an  inch  in  length.  In 
"  hb "  both  ends  are  beveled  inward  to  enable  them  more 
easily  to  slip  over  the  parts  to  be  held.  In  "  cc  "  one  end  of 
the  clip  is  formed  into  a  loop  and  the  other  bent  at  a  right 
angle  with  fiat  termination.  "  dd "  is  a  modification  of 
''  66,"  one  arm  being  curved  near  its  end  to  hold  a  tube  in 
parallel  position  upon  a  band. 

"  ^p' "  is  intended  to  represent  the  manner  of  holding  a 
tube  at  right  angles  to  the  length  of  the  band.  The  wire 
clip  for  this  jDurpose  has  one  arm  bent  at  a  right  angle  near 
its  end  and  flattened  and  made  concave  to  fit  the  tubing, 
while  the  other  arm  is  straight,  as  in  "  66." 

"  hh "  represents  an  angled  prong  for  holding  parts  in 
position  upon  a  soldering  block,  as  in  constructing  a  gold 
T.  It  is  made  from  a  piece  of  piano-wire  flattened  and 
drilled  at  one  end,  tapering  to  a  point  at  the  other  and  bent 
at  a  right  angle  near  the  middle.  The  pointed  end  is  easily 
forced  into  an  asbestos  or  charcoal  block  at  any  desired  place. 

Ferrules  or  Bands. — Ferrules  or  bands  for  encircling  teeth 
and  serving  as  means  of  attachment  for  operating  or  retain- 
ing appliances  may  be  made  from  gold  plate  (18  to  22  karats 
fine),  platinous  gold,  iridio-platinum,  platinum,  platinous 
silver  or  German  silver.  All  of  those  mentioned,  except  the 
last,  will  remain  nearly  free  from  oxidation,  but  German 
silver  soon  becomes  discolored  in  the  mouth.     As  a  rule, 


Plate  I. 


Plate  II. 


CONSTKUCTION    OF    APPLIANCES.  235 

bands  should  be  made  to  fit  loosely  so  as  to  afford  slight 
space  for  the  cement  which  is  to  hold  them  in  position,  and 
where  practicable,  the  tooth  to  be  fitted  should  be  freed  from 
contact  with  its  neighbors  by  previous  wedging.  As  this 
cannot  always  be  done,  the  bands  in  some  cases  will  have  to 
be  forced  over  the  teeth  in  spite  of  their  contact.  In  such 
case  they  should  be  constructed  from  the  stiffest  and  least 
yielding  of  the  metals  mentioned,  such  as  platinous  gold, 
platinous  silver,  or  iridio-platinum.  Bands  made  from  these 
metals,  even  though  thin,  will  retain  their  form  without 
''  buckling  "  while  being  forced  into  place.  Where  the  teeth 
to  be  banded  are  not  in  close  contact,  any  of  the  other 
metals  will  serve  as  well  for  the  construction  of  bands.  The 
band  material  should  not  exceed  No.  32  in  thickness  and 
be  cut  into  strips  from  -^-^  to  -^^  of  an  inch  in  width. 

For  the  six  anterior  teeth  the  strips  should  be  curved  as 
shown  in  "  z,"  so  that  when  bent  to  encircle  the  tooth  with 
the  convex  edge  toward  the  gum,  the  ends  will  meet  one 
another  or  overlap  on  the  lingual  surface  in  a  nearly  hori- 
zontal line. 

For  molars  and  bicuspids  the  band  should  be  straight, 
and  if  desired,  may  be  contoured  transversely  with  the  con- 
touring pliers  (o). 

Ferrules  are  strongest  when  made  with  a  lap  joint,  and 
their  ends  may  be  held  in  close  apposition  by  passing  bind- 
ing wire  around  them  {aa)  and  twisting  the  ends  to  serve  as 
a,  holder  while  soldering  in  the  flame  of  a  lamp,  or  the 
lapped  ends  may  be  held  with  a  wire  clip  {hh). 

In  some  cases,  as  in  partly  erupted  cuspids  and  deciduous 
molars,  where  the  exposed  portion  of  the  crown  is  short  and 
conical,  it  is  better  to  have  a  cap  entirely  covering  the  crown 
so  as  to  gain  a  firmer  hold. 

This  is  easily  made  by  reproducing  the  crown  in  Melotte's 
metal,  and  after  roughly  adaj)ting  the  cap  to  the  natural 
tooth  or  its  duplicate  in  plaster,  completing  the  operation  by 
swaging  it  between  a  die  and  counter. 


236 


ORTHODONTIA. 


Fig.   203. 


Matteson  Caps. 


Prof.  Matteson's  method  of  doing  this  is  well  shown  in 
Fig.  203. 

For  a  partly  erupted  cuspid  he  takes  a  circular  piece  of 

plate,  and  after  cut- 
ting from  it  a  seg- 
ment, as  in  (b)  bends 
it  into  the  form  of  a 
cone  (c)  and  solders- 
the  edges.  It  is  then 
swaged  to  form  be- 
tween a  die  and  coun- 
ter. For  a  deciduous 
molar  he  cuts  the 
plate  into  the  form  of 
a  cross  (d),  folds  the 
arms  down,  then  swages  and  solders.  In  some  cases,  for 
more  secure  anchorage,  he  forms  a  chain  of  caps  (/)  by 
soldering  several  together. 

The  attachments  that  bands  are  most  commonly  supplied 
with  are  headed  pins,  wire  hooks  and  pieces  of  metal  tubing. 

Tubes  are  held  in  position  upon 
bands  for  soldering  by  means  of  wire- 
clips  as  shown  in  (dd)  and  [gy),  or 
they  ma}''  be  held  by  means  of  a 
pointed  instrument  passed  through 
the  tube  as  in  Fig.  204. 


As  tubes  are  usually  not  soldered 
along  their  edges  after  being  drawn, 
the}"  can  be  closed  at  the  time  of 
soldering  to  the  bands  by  placing 
the  joint  next  to  the  band,  and  when 
desired  to  be  left  open  the  joint  is  turned  away  so  as  not  to 
be  included  in  the  soldering. 

Headed  pins  may  be  obtained  from  a  vulcanite  tooth,  and 
after  being   filed  to   a   point   can   be   inserted  into  a  hole 


Fig.  204. 


Angle's  Plan. 


drilled  in  the  band,  as  shown  in  "J". 


CONSTRUCTION    OF    APPLIANCES. 


237 


Fig.  205. 


When  a  band  is  to  be  supplied  with  hooks  on  opposite 
sides,  a  convenient  way  of  attaching  them  is  to  drill  a  hole 
in  each  side  of  the  band  and  pass  entirel}'  through  them  a 
wire  bent  into  a  hook  at  one  end  as  shown  in  "  ee."  After 
soldering,  the  straight  end  is  also  bent  and  the  wire  cut 
from  the  centre  of  the  band.  A  hook  for  one  side  only  may 
be  inserted  and  held  like  the  pin  in  "ff"  or  a  long  wire, 
serving  as  a  handle,  may 
have  its  end  tapered,  in- 
serted into  the  hole  in  the 
band  and  soldered  over  a 
lamj) ;  after  which  it  is  cut 
to  proper  length,  and  the 
■end  bent    into   the   form    of 

a    hook,  as    in    Fig.    205.  ^  Bands  with  Hooks. 

Round  Tubing. — Tubing  for  pipes  or  tubes  can  usually  be 
obtained  at  jeweler's  supply  houses.  It  may  be  had  of  gold, 
brass  or  German  silver  or  of  one  of  the  latter  metals  plated. 
It  comes  in  lengths  of  about  four  inches,  and  is  smoothly 
drawn  but  not  soldered  (  x ). 

The  thickne-ss  of  the  tubes  is  generally  greater  than  we 
desire,  but  after  soldering  the  joints  with  silver  solder, 
the  inside  diameter  can  be  enlarged  with  an  engine  bur,  a 
spear  or  fissure  drill,  or  jeweler's  reamer.  In  many  cases  it 
may  be  desirable  or  necessary  to  manufacture  our  own 
tubing,  which  can  be  done  as  follows:  Select  a  piece  of 
metal  plate  of  suitable  gauge  (No.  27)  and  cut  from  it  a  strip 
of  desired  length  and  of  a  Avidth  equal  to  three  and  a  third 
times  the  outside  diameter  of  the  proposed  tuljing  (v).  Shape 
one  end  of  the  strip  like  the  nib  of  a  pen  and  curve  or  round 
the  entire  piece  somewhat  by  forcing  it  into  a  groove  cut  in 
a  block  of  hard  wood,  using  a  piece  of  wire  and  hammer  for 
the  purpose  (iv).  The  pointed  end  is  then  passed  into  one 
of  the  larger  holes  of  the  draw-plate,  seized  with  the  pliers 
(i)  and  drawn  through.  This  operation  is  repeated  through 
the  holes  next  in  size  until  the  cut  edges  of  the  strip  are  in 


238  ORTHODONTIA. 

close  apposition.  If  it  be  desired  to  reduce  the  external 
diameter  after  the  tube  is  formed,  it  can  be  done  by  simply- 
continuing  the  process.  As  the  drawing  stiffens  the  metal 
it  will  be  necessary  to  anneal  it  occasionally  during  the 
process.  Where  the  tubing  is  to  be  used  in  considerable 
lengths  without  soldering,  where  great  stiffness  is  required, 
as  in  the  Angle  encasement  for  jack-screws,  there  should  be 
no  annealing  of  the  metal  near  the  close  of  the  operation  of 
drawing. 

Square  Tubing. — This  form  of  tubing  cannot  always  be 
bought,  and  so  may  have  to  be  manufactured.  The  strip 
should  first  be  converted  into  a  round  tube,  as  previously 
described,  and  drawn  to  near  the  projDer  size  in  the  ordinary 
draw-plate,  after  which  the  last  four  or  five  drawings  must 
be  made  through  a  square  hole  draw-plate.  When  made  of 
plate  a  little  heavier  than  usual,  and   drawn  to  a  size  to  fit 

the  wrench   or  kev,  it  is  ad- 

FlG.   206.  .      ,  ,  ^       ^     ^    /     J_^ 

mn'ably  adapted  lor  the  con- 
^^^^^^^^^^    ^^  struction    of  small    nuts   as 

Square  Tubing.  WCll      aS      lieads      of      SCTCWS. 

See  Fig.  206. 

Sections  of  any  length  can  be  cut  from  it  with  a  jeweler's 
saw,  after  which  by  grasping  them  in  a  hand-vise  {b)  they 
may  be  readily  drilled  or  reamed  to  proper  size  and  tapped. 
The  saw  should  always  be  set  in  the  frame  with  the  teeth 
pointing  toward  the  handle  so  that  the  cutting  is  done  in 
drawing  the  saw  backward.  Reversing  the  operation  would 
cause  the  back  of  the  frame  to  spring  and  the  saw  be  liable 
to  break  in  consequence. 

Wire-Drawing. — The  ]3rocess  of  drawing  wire  down  to  size 
is  very  similar  to  that  of  drawing  round  tubing.  Steel  wire 
cannot  be  drawn  by  hand,  but  can  be  bought  in  all  sizes. 
Gold,  platinum,  platinous  silver  or  German  silver  wire, 
however,  can  readily  be  reduced  in  diameter  and  corres- 
pondingly lengthened  by  means  of  the  draw-plate  (u)  and 
the  heavy  pliers  {i).     Before  using  the  draw-plate,  the  holes 


CONSTRUCTION    OF    APPLIANCES.  239 

should  be  filled  with  melted  bees-wax  or  equal  parts  of 
bees- wax  and  tallow  to  act  as  a  lubricant.  It  is  then 
clamped  firmly  in  the  bench-vise.  The  wire  after  being 
annealed  should  be  reduced  at  one  end  by  filing  or  hammer- 
ing and  the  pointed  end  passed  through  the  hole  in  the  draw- 
plate  next  less  in  diameter  than  the  wire  itself.  It  is  then 
grasped  by  the  pliers  (i)  and  drawn  through  with  a  con- 
tinuous and  steady  pull.  In  similar  manner  it  is  drawn 
through  the  successively  smaller  holes  until  the  desired 
gauge  is  obtained.  After  each  three  or  four  drawings  the 
wire  should  be  annealed. 

Bendlvg  Wire. — Wire  may  be  bent  into  any  form  by  means 
of  the  various  pliers,  assisted  at  times  by  the  bench-  or  hand- 
vise.  Any  curve  can  be  given  to  it  with  the  round-nose 
pliers  {h),  or  the  clasp  bender  (e),  w^hile  for  bending  it  at  a 
right  or  acute  angle,  it  should  be  held  in  the  vise  or  pliers 
close  to  the  bending  point  and  the  free  end  grasped  and 
bent  over  with  the  flat-nose  pliers.  If  the  ware  be  of  large 
size  it  may  best  be  bent  at  a  right  angle  by  grasping  it  in 
the  bench-vise  and  forcing  the  free  end  down  with  a 
hammer. 

When  piano  wire  needs  a  sharp  bend  it  should  always  be 
done  in  this  latter  manner.  For  bending  piano  wire  into  a 
short  curve,  as  for  making  or  altering  the  form  of  the  Coffin 
W-spring,  the  clasp-benders  (e)  should  be  used,  on  account 
of  their  convenience  and  superior  power. 

Soft' Soldering. — In  uniting  small  parts  of  appliances  by 
means  of  soft-solder,  they  may  be  held  in  the  tweezers  (/), 
{t),  or  the  spring  clips  hb,  cc,  dd,  or  wrapped  with  binding 
wire.  After  applying  the  soldering  fluid,  the  piece  is  held 
over  an  annealing  lamp  and  when  sufficiently  heated  is 
touched  with  the  end  of  a  thin  rod  of  solder  which  at  once 
melts  and  unites  the  parts.  In  this  way  the  minimum 
amount  of  solder  may  be  applied. 

For  soldering  larger  parts  of  appliances,  as  in  forming  the 
Jackson  cribs  and  springs,  they  should  be  secured  in  proper 


240  ORTHODONTIA. 

position  on  the  plaster  model,  and  after  applying  the  fluid 
and  laying  a  piece  of  solder  on  the  parts,  the  latter  is 
melted  and  the  parts  joined  with  a  soldering  iron  previously 
heated  over  a  Bunsen  burner.  In  soldering  steel  (as  piano- 
wire)  the  fluid  causes  oxidation  of  the  metal  so  quickly  that 
it  is  important  to  heat  the  parts  and  melt  the  solder  imme- 
diately after  the  fluid  is  applied. 

Hard-Soldering. — Both  the  student  and  practitioner  are 
supposed  to  be  familiar  with  this  process,  so  that  few  sug- 
gestions will  be  needed. 

Parts  of  German  silver  appliances  should  be  soldered  with 
silver  solder  (silver  2,  brass  1)  while  any  of  the  compounds 
of  gold  or  platinum  may  be  united  with  either  silver  or 
gold  solder.  The  latter  when  used  should  not  be  less  than 
18  karats  fine  to  keep  its  color  in  the  mouth.  In  joining 
articles  with  hard  solder  the  parts  to  be  united  should  be 
touched  with  the  least  quantity  of  liquified  borax  and  only 
as  much  solder  applied  as  is  necessary. 

After  drying  with  moderate  heat,  the  full  flame  should  be 
directed  upon  the  parts  to  be  united  and  fusion  accom- 
plished as  quickly  as  possible.  Most  of  the  hard-soldering 
required  in  constructing  portions  of  regulating  appliances 
may  be  done  by  holding  the  parts  in  the  flame  of  a  small 
Bunsen  burner  or  alcohol  annealing  lamp.  In  other  cases 
a  larger  flame  with  a  blow-pipe  to  direct  and  concentrate  it 
will  be  necessary,  the  parts  being  laid  or  secured  in  position 
upon  a  soldering  block  made  of  charcoal,  asbestos,  pumice- 
stone  or  other  suitable  substance. 

When  two  solderings  are  necessary  for  the  same  piece,  the 
first  joint  may  be  kept  from  unsoldering  during  the  second 
process  by  placing  an  extra  wire  clip  upon  it  or  by  seizing 
it  with  the  tweezers  at  that  point  and  thus  protecting  it 
from  over-heating. 

In  soldering  bands  together  as  in  Fig.  30,  page  91,  they 
may  conveniently  be  held  by  means  of  the  clip  "  bh,"  while  a 
band  and  bar,  as  in  Fig.  28,  mav  be  held  in  the  same  manner. 


CONSTRUCTION    OF    APPLIANCES.  241 

When  two  j^ieces  of  tubing  are  to  be  united  at  other  than 
a  right  angle,  they  may  be  arranged  and  held  in  position 
upon  tlie  soldering  block  by  being  pinned  down  with  staples 
made  from  piano  wire.  The  end  of  one  piece  will  of  course 
have  to  be  filed  concave  to  fit  the  convex  surface  of  the 
other,  before  joining. 

AVhere  it  is  desired  to  lengthen  a  traction  screw,  it  may  be 
done  with  less  labor  than  constructing  a  new  one,  by  cutting 
it  in  two  at  some  point,  inserting  a  new  piece  of  like  diame- 
ter, and  uniting  with  solder.  The  parts  may  be  held  in 
position  by  being  i)inned  to  some  smooth  surface  of  the 
soldering  block,  or  a  groove  may  be  made  in  the  block  with 
a  straight  piece  of  wire  and  hammer  and  the  parts  to  be 
united  laid  into  it.  A  wire  may  be  shortened  in  like 
manner. 

When  a  wire  or  a  tube  is  to  be  joined  to  another  at  a  right 
angle,  they  may  be  held  as  shown  in  "A/?,"  which  is  also 
one  of  the  best  means  for  holding  two  flat  pieces  of  metal  for 
soldering,  as  in  constructing  a  T  appliance. 

A  screw  cut  wire  may  be  fitted  with  a  square  end  for. 
turning  with  a  key,  by  filing  it  to  a  smaller  diameter  and 
slipping  over  it  and  soldering  a  section  of  square  tubing.  If 
a  shoulder  is  wanted  in  addition,  a  small  washer  or  disk 
may  be  placed  on  the  wire  before  the  square  tubing  is 
adjusted.     Both  will  be  united  at  the  same  soldering. 

Screws  and  Nuts. — The  making  of  jack-  or  traction-screws 
and  nuts  to  play  upon  them  is  an  operation  requiring  care, 
hut  is  not  beset  with  much  difficulty. 

•Jeweler's  sets  of  taps  and  dies  and  the  ordinary  screw- 
plate  are  not  very  serviceable  for  our  use,  as  the  thread  they 
€ut  is  too  fine  (too  many  threads  to  the  inch)  and  conse- 
quently liable  to  strip  when  much  force  is  applied.  The 
author  has  succeeded  in  having  made  a  set  of  screw  cutting 
appliances  consisting  of  a  die  and  adjustable  die-holder  for 
outting  screws,  and  two  taps  for  threading  nuts.  They  cut 
a  clean,   sharp  and  coarse  thread,  gauge  .049  of  an  inch, 


242  ORTHODONTIA. 

which  is  the  single  size  found  most  suitable  for  regulat- 
ing purposes.  The  set  is  illustrated  at  foot  of  Plate  L* 
It,  with  a  bench  or  pin-vise,  and  a  few  tools  such  as  files 
and  pliers,  together  with  a  few  sizes  of  jeweler's  reamers,  will 
furnish  us  with  all  the  equipment  we  need  for  the  purpose. 

Screws. — The  wire  that  is  to  be  threaded  or  screw-cut, 
should  be  smoothly  drawn  and  of  moderate  temper.  The 
form  that  one  end  of  the  wire  is  to  have  may  be  given  to  it 
either  before  or  after  the  thread  is  cut  upon  the  other,  but  in 
most  cases  it  will  be  well  to  fashion  it  first.  The  wire  should 
be  of  exactly  the  same  diameter  as  the  hole  in  the  die 
would  be  if  the  threads  were  removed.  If  smaller  than 
this,  a  full,  deep  thread  will  not  be  cut,  and  if  larger,  the 
wire  will  be  liable  to  be  twisted  off  in  the  attempt.  In  cut- 
ting the  thread,  tlie  wire  should  be  slightly  tapered  at  its 
end  and  grasped  in  the  bench-vise,  horizontally  or  vertically, 
with  only  about  half  an  inch  of  its  length  protruding.  To 
avoid  marring  the  wire,  the  jaws  of  the  vise  should  be  pro- 
vided with  lead  or  brass  caps. 

The  die  (in  holder)  should  now  be  held  against  the  end  of 
the  wire  at  right  angles  to  it  and  given  a  quarter  or  half 
turn  with  firm  pressure.  This  should  be  repeated  four  or 
five  times  until  the  tool  is  well  started  in  its  work,  care 
being  taken  to  preserve  the  forward  pressure  and  to  see  that 
the  screw-plate  is  kept  at  a  right  angle  to  the  wire.  The 
operation  may  now  proceed  more  rapidly  until  all  of  the 
exposed  portion  of  the  wire  has  been  covered. 

If  a  longer  portion  is  to  be  threaded,  more  of  the  wire  may 
now  be  exposed  and  the  operation  continued.  A  little  oil 
fed  to  the  tool  will  greatly  facilitate  the  cutting.  In  revers- 
ing the  operation  to  release  the  tool,  care  should  be  exercised 
not  to  mar  the  thread. f 


*  It  may  be  ordered  from  Geo.  P.  Pilling  &  Sons,  1225  CallowMll  Street, 
Phila.,  from  whom  also  all  kinds  and  sizes  of  wire  and  tubing  can  be  obtained. 

t  German  silver  wire  of  any  size  can  be  procured  at  electrical  supply 
houses.  The  size  best  adapted  for  jack-  and  traction-screws  is  No.  17, 
(  B.  &  S. )  corresponding  to  hole  No.  17  in  the  Joubert  draw-plate. 


CONSTRUCTION    OF    APPLIANCES. 


243: 


Nuts. — For  use  in  regulating  appliances,  nuts  should  be 
square,  about  No.  13  in  diameter,  and  not  less  than  •3^2-  of  ^^ 
inch  in  length  in  order  to  have  a  good  hold  and  resist  the 
necessary  strain.  When  greater  strain  than  ordinary  is  to 
be  withstood,  they  should  be  longer  to  prevent  stripping  of 
the  thread.  They  should  be  made  from  heavy,  square, 
German  silver  tubing,  by 
sawing  it  into  sections,  grasp- 
ing these  in  the  pin-vise  (6) 
and  then  drilling  and  tap- 
ping them. 

In  using  the  tap  to  cut  the 
threads  on  the  inside  of  these  nuts,  it  should  be  oiled,  held 
in  a  suitable  holder  and  fed  carefully  with  an  alternate- 
forward  and  backward  movement  to  avoid  clogging  and 
danger  of  breaking  the  highly  tempered  tool. 

Fig.  208. 


Fig.  207. 


Angle  Drag-Screws. 


Wrenches. 


If  the  tubing  from  which  the  nuts  are  to  be  made  has  not 
been  soldered  after  being  drawn,  it  should  be  before  it  is  cut 
into  sections. 

Fig.  207  shows  the  Angle  form  of  drag-screws,  and  Fig. 
208  two  forms  of  wrenches  most  suitable  for  turning  the 
nuts. 


244 


ORTHODONTIA. 


Comparative  Table. 

Showing  Sizes  of  Wire  and  Plate  in  Decimals  of  an  Inch  by  Vari- 
ous Wire  G-auges. 


No.  of 

English 

Stub's  and 

American  Standard 

Gauge. 

Standard. 

Birmingham. 

Brown  &  Sharpe. 

5 

.220 

.220 

.18194 

6 

.203 

.203 

.16202 

7 

.180 

.180 

.14428 

8 

.165 

.165 

.12849 

9 

.148 

.148 

.11443 

10 

.134 

.134 

.10189 

11 

.120 

.120 

.09074 

12 

.109 

.109 

.08081 

13 

.095 

.095 

.07196 

14 

.083 

.083 

.06408 

15 

.072 

.072 

.05706 

• 

16 

.065 

.065 

.05082 

17 

.053 

.058 

.04525 

18 

.049 

.049 

.04030 

19 

.040 

.042 

.03589 

20 

.035 

.035 

.03196 

21 

.0315 

.032 

.02846 

22 

.0295 

.028 

.02533 

23 

.027 

.025 

.02257 

24 

.025 

.022 

.0201 

25 

.023 

.020 

.0179 

26 

.0205 

.018 

.01594 

27 

.01875 

.016 

.01419 

28 

.0165 

.014 

.01264 

29 

.0155 

.013 

.01125 

30 

.01375 

.012 

.01092 

31 

.01225 

.010 

.00892 

32 

.01125 

.009 

.00791 

33 

.01025 

.008 

.00708 

34 

.0095 

.007 

.0063 

35 

.009 

.005 

.00561 

36 

.0075 

.004 

.0(15 

111  explanation  of  the  above  table  it  may  be  stated  that 
the  numbers  in  the  first  column  refer  to  the  numbers  on 
the  various  gauge-plates,  and  their  respective  equivalents,  in 
decimals  of  an  inch,  will  be  found  in  one  of  the  other 
columns.  Thus  No.  17  of  the  B.  &  S.  gauge  is  equal  to 
.04525  of  an  inch,  while  No.  17  of  the  English  standard  is 
equal  to  .058,  or  a  trifle  more  than  .010  greater  than  that  of 
theB.  &S. 


CHAPTER  II. 

ELECTRO-PLATING. 

Electro-plating  is  the  art  of  precipitating  certain  metal,?- 
from  their  sohitions  by  the  slow  action  of  a  galvanic  current. 
By  this  process  the  salts  of  the  metals  in  solution  are  decom- 
posed, the  metal  being  deposited  upon  the  object  to  be  plated 
at  the  negative  pole  while  acid  is  liberated  at  the  positive 
one.  Electro-gilding,  or  plating  with  gold,  is  emploj'^ed  in 
dentistry  chiefly  for  the  purpose  of  giving  to  appliances  made 
from  the  baser  or  oxidizable  metals  a  coating  of  finer  metal 
(gold)  that  will  resist  the  action  of  the  fluids  of  the  mouth. 

Regulating  appliances  made  from  German  silver  or 
steel,  in  whole  or  in  part,  not  only  present  a  better  appear- 
ance, but  endure  longer  and  operate  more  satisfactorily  when 
properly  gilded. 

Piano-wire,  so  valuable  and  so  largely  employed  in  con- 
nection with  regulating  devices,  not  only  becomes  unsightly, 
but  deteriorates  when  worn  for  a  long  time  in  the  mouth. 
It  may  be  bought  electro-gilded,  but  the  coating  is  so  thin 
as  not  to  be  durable. 

German  silver,  which  is  rapidly  growing  in  favor  for  the 
construction  of  regulating  appliances  on  account  of  its  inex- 
pensiveness  and  intrinsic  merits,  is  also  readily  acted  upon 
by  the  fluids  of  the  mouth  and  the  resultant  oxidation 
greatly  interferes  with  the  operation  of  nuts  and  screws  or 
the  play  of  wires  in  their  neatly  fitting  tubes.  Gilding- 
obviates  all  of  these  disadvantages  and  gives  us  the  virtue 
of  gold  without  its  expensiveness.    . 

German  silver  is  easily  gilded  in  either  a  warm  or  cold 
bath  if  its  surface  be  first  thoroughly  cleansed ;  but  steel, 
owing  to  its  ready  oxiclability  in^  the  cleansing  bath,  does- 

245 


"246  ORTHODONTIA. 

not  receive  a  good  and  durable  coating  of  gold  unless  it  is 
first  plated  with  copper.  Steel  therefore  requires  to  be 
subjected  to  two  processes,  while  German  silver  or  other 
alloys  of  copper  need  but  one.  Each  of  these  processes  will 
be  described. 

As  a  preliminary  to  plating,  all  articles  must  have  a 
perfectly  clean  surface,  otherwise  the  deposit  will  not  adhere 
firmly  to  the  object  receiving  it  and  the  durability  of  the 
■€oating  be  greatly  lessened. 

During  both  processes  of  cleansing  and  plating,  the  article 
must  not  be  touched  with  the  fingers,  as  the  slightest  contact 
will  prevent  the  adhesion  of  the  metal  at  such  points.  To 
prevent  this  the  article  to  be  plated  should  have  a  copper  or 
platinum  wire  attached  to  it  at  some  point  by  means  of 
which  it  must  always  be  handled  until  the  entire  operation 
is  completed. 

CLEANSING    GERMAN    SILVER,    BRASS    AND    OTHER 
COPPER    ALLOYS. 

The  following  is  one  of  the  best  formulae  for  a  cleansing 

.solution : 

Caustic  potash,  .  .  .  .•  .  lib. 

Water,  (soft)  .....  1  gal. 

Heat  nearly  to  boiling  point  in  a  glass,  porcelain  or 
porcelain-lined  dish,  and  susj^end  the  article  for  a  few 
minutes  in  the  hot  solution. 

Remove  and  brush  thoroughly  uj)on  a  board,  after  which 
rinse  well  in  clean  water.  If  the  article  is  soft-soldered  at 
any  point  it  must  not  remain  in  the  lye  too  long  or  the  solder 
will  be  acted  upon. 

CLEANSING    STEEL. 

Dip  in  the  caustic  lye  used  for  copper,  rinse  thoroughly, 
iscour  with  moistened  pumice,  rise  again  and  pass  through 
ib.Q  following  dip : 

Sulphuric  acid,       .....  1  part. 

Water,         ...  ...  20  parts. 


ELECTRO-PLATING.  247 

After  this  the  article  must  again  be  well  rinsed  before 
being  placed  in  the  plating  bath. 

COPPER    SOLUTION. 

The  electro  deposit  of  copper  is  usually  obtained  by  the 
decomposition  of  acetate  of  copper  and  cyanide  of  potassium. 
A  good  bath  or  solution  is  as  follows : 


Water,  (soft) 

1  gal. 

Acetate  of  copper,  (crystals) 

3}  ozs 

Carbonate  of  soda,  (crystals) 

3}  ozs 

Bisulphite  of  soda, 

3  ozs. 

Cyanide  of  potassium,  (pure) 

7J  ozs 

Moisten  the  copper  salt  with  water  to  form  a  paste,  (other- 
wise it  is  apt  to  float  on  the  liquid) ;  stir  in  next  the  carbonate 
of  soda  with  a  little  more  water,  then  the  bisulphite,  and 
finally  the  cyanide  with  the  rest  of  the  water. 

When  solution  is  complete,  the  liquid  should  be  nearly 
colorless.     If  not,  add  cyanide  until  it  is. 

This  bath  may  be  used  either  hot  or  cold. 

An  immersion  of  a  few  minutes  will  usually  furnish  a 
sufficient  coating  of  copper  when  the  article  is  afterward  to 
be  gilded. 

GOLD    SOLUTION. 

Formula : 

Chloride  of  gold,     .....  72  grs. 

Cyanide  of  potassium,  (pure)         .  .  .  IJ  ozs. 

Water,  (distilled)  ....  30  ozs. 

Dissolve  the  cyanide  in  part  of  the  water,  then  gradually 
add  the  gold  chloride*  dissolved  in  the  remainder.  Boil  for 
one-half  hour  and  use  cold.  The  solution  prepared  as  above 
should  be  colorless  after  standing  awhile,  and  the  color  of 
the  deposit  should  be  yellow.  If  black  or  dark  red,  add 
more  cyanide  dissolved  in  water.  If  cyanide  be  in  excess, 
plating  will  proceed  slowly  or  not  at  all ;  in  such  case  add 
more  gold  chloride  or  increase  intensity  of  current  by  im- 

*Chloride  of  gold  can  be  purchased  at  chemical  supply  houses. 


248 


ORTHODONTIA. 


mersing  zincs  deeper  in  cell.  In  gilding  German  silver,  the 
best  results  are  obtained  when  the  bath  is  kept  slightly 
warm. 

All  gilding  baths  should  be  stirred  occasionally  to 
destroy  the  gravity  of  the  liquids. 

BATTERY. 

For  small  articles,  such  as  regulating  appliances,  a  single 
cell  (Daniel  or  Smee)  will  give  us  sufficient  intensity  of 
current. 

Fig.  209  represents  a  simple  battery  composed  of  a  single 
Smee  cell  connected  with  the  jar  containing  solution  and 

articles  to  be  plated.* 
In  the  illustration 
of  the  battery,  "  z  " 
represents  the  zinc 
plates  and  "  s  "  a  strip 
of  platinized  silver 
suspended  between 
them.  "  ^o "  is  a 
wooden  support 
which  rests  upon  the 
edges  of  the  jar  with 
the  silver  strip  let 
into  its  under  surface.  "  5  "  is  a  clamp  connecting  the  two 
zinc  plates  on  the  outside  of  the  wooden  support,  while  clamp 
"  a  "  connects  with  the  silver  strip.  The  plating  or  bath  jar 
has  two  copper  rods  resting  upon  it,  one  of  which  "  cl "  has 
the  metal  anode  suspended  from  it  by  means  of  a  platinum 
or  copper  wire,  while  the  other  "  c  "  has  the  cathode  or  article 
to  be  plated  similarly  suspended. 

The  battery  jar  or  cell  is  charged  with  a  solution  of  one 
part  of  sulphuric  acid  to  ten  parts  of  water.     The  current 


Plating  Battery 


*A  Smee  cell  with  platinized  silver  plate  can  be  bought  at  any  electrical 
supply  house  for  $3.50,  and  additional  plain  glasa  jars,  one  for  copper  and 
the  other  for  gold  solution,  for  about  15  cents  each. 


ELECTEO-PLATING.  249 

generated  by  the  action  of  the  acid  sokition  upon  the  zinc 
plates  passes  through  the  j)ositiYe  (+)  wire  to  the  rod  "  c?," 
into  the  plating  solution  by  way  of  the  anode  (f),  across  to 
the  cathode  (e)  and  back  to  the  battery  by  way  of  the 
negative  wire  ( - ).  The  current  in  its  passage  decomposes  a 
portion  of  the  gilding  solution  and  causes  the  metal  thus 
set  free  to  be  attracted  to  and  deposited  ujDon  the  article  to 
be  plated. 

The  solution  being  thus  deprived  of  a  portion  of  its  con- 
stituent salt,  in  turns  acts  upon  the  suspended  anode  and 
takes  from  it  a  sufficiency  of  the  metal  to  restore  its  former 
equilibrium.  In  this  way,  as  each  article  is  coated  with  the 
metal,  the  suspended  anode  is  eaten  away  to  replace  the  loss 
and  the  solution  suffers  no  great  diminution  of  strength. 
The  anode  for  copper  plating  consists  of  a  piece  of  sheet 
copper,  while  for  gilding,  the  anode  should  be  of  pure  gold 
and  can  be  made  by  melting  gold  foil  scraps  into  a  button 
and  then  hammering  it  into  a  thin  sheet.  All  anodes  should 
have  perfectly  clean  surfaces  in  order  that  they  may  be 
readily  acted  upon. 

PLATING. 

With  the  battery  in  position  and  the  jars  filled  to  within 
about  two  inches  of  their  tops  with  their  respective  licj^uids, 
the  operation  of  plating  is  a  very  simple  one.  After  the 
article  to  be  plated  has  been  made  smooth  and  polished  and 
properly  cleansed  in  the  cleansing  solution,  it  is  rinsed  in 
water,  and  if  other  than  steel,  is  immediately  suspended  in 
the  plating  solution  from  the  copjDer  rod  "  c."  The  corres- 
ponding anode  is  hung  upon  the  other  rod  "  rf,"  when  the 
deposit  of  metal  at  once  begins.  The  length  of  time 
necessary  to  secure  a  good  coating  will  vary  somewhat  with 
the  strength  of  the  solution,  the  intensity  of  the  current  and 
the  metal  to  be  plated.  Usually  from  ten  to  twenty 
minutes  will  be  sufficient,  but  a  little  practice  will  be  neces- 
sary to  determine  the  time  and  secure  the  best  results.     If 


250  ORTHODONTIA. 

on  removal  the  deposit  is  found  to  be  too  light,  the  article 
can  again  be  placed  in  the  bath  and  more  added.  When 
finally  removed  from  the  bath  it  should  be  held  in  running 
water  and  then  dried. 

If  the  article  has  a  dead  finish  when  placed  in  the  bath, 
it  will  present  a  similar  appearance  when  plated.  If  polished 
in  the  first  instance,  the  deposit  will  have  a  polished  appear- 
ance provided  the  current  be  not  too  strong. 

The  process  of  plating  steel  differs  from  the  one  just 
described  in  requiring  the  article  to  be  dipped  for  a  moment 
in  the  sulphuric  acid  solution  after  it  comes  from  the 
cleansing  solution  and  before  it  is  placed  in  the  copper  plat- 
ing bath.  After  receiving  a  fair  coating  of  copper  it  is 
washed  and  then  placed  in  the  gold  bath  and  gilded  as 
described. 

The  deposition  of  the  metal  in  any  case  usually  progresses 
more  quickly  and  evenly  when  the  article  to  be  plated  is 
separated  by  about  two  inches  from  the  anode  and  is  slightly 
agitated  while  in  the  bath. 

When  the  battery  is  not  in  use  the  anode  should  be  re- 
moved from  the  plating  solution  and  the  zincs  be  elevated 
above  the  liquid  in  the  battery.  Both  jars  should  also  be 
covered  to  protect  them  from  dust. 

Plating  without  a  Battery. — A  sim|)le  method  of  gilding- 
metallic  articles  is  by  the  use  of  so-called  gilding  solutions. 
These  preparations  consist  of  gold  dissolved  in  an  acidulous 
liquid  and  the  deposit  takes  place  when  the  article  to  be 
plated  is  placed  in  the  solution  by  the  side  of  and  touching 
a  piece  of  clean  zinc.  The  latest  claimant  for  favor,  among 
this  class  of  preparations,  is  Pohlman's  Gilding  Solution. 
All  of  them  will  give  a  coating  of  gold  to  the  article  placed 
in  them,  but  the  coating  is  very  slight  (unless  the  operation 
be  repeated  several  times),  and  they  are  in  no  wise  as 
satisfactory  as  the  battery  plating  previously  described. 


INDEX. 


251 


IN  DEX. 


Acquired  irregularities,  14. 
Adenoid  vegetations   as  a  cause   of 

irregularities,  20. 
Adjustable  bow-spring,  129. 
Age,  consideration    of  in  correction 

of  irregularities,  32,  37. 
Allen's  retraction  device,  199. 
Alveolar  process,  physiology  of,  50. 
removal  of  in  luxation  of  teeth, 

224. 
Anchorage  attachments,  77,  193. 

—  —  in  tooth-movement,  58. 
■  reciprocal,  102. 

—  —  re-enforced,  101. 
Angle's  impression  cups,  72. 

■ —  method  of  constructing  bands,  236. 

—  retainer,  92. 

—  regulating  methods,  61,   99,   125, 

137,  143,  147,  150,  162,  165,  166, 
174,  184,  186. 
Anterior  occlusion,  lack  of,  204. 

—  teeth,  regulation  of,  42. 
Approximal   surfaces,    trimming  of, 

229. 
Arch,  expansion  of,  104,  167. 

—  constricted,  27. 

—  lancet,  26. 

Articulated  models,  usefulness  of,  74. 
'  Articulator,  Guilford's,  73. 

Baker,  H.  A.,  case  of  mal-occlusion, 
205. 

—  retainer,  93. 

Band  and  bar  retaining  appliances, 
91. 

—  and  wire  retainer,  92. 

Bands,  retaining,  construction  of,  234. 

—  use  of  in  moving  teeth,  60,  78. 
Battery  for  electro-plating,  248. 
Bedell's    regulating   appliance,  132. 
Bicuspids,  regulation  of,  151. 
Bryan,  L.  C,  surgical  treatment  of 

irregularities,  221. 
Bryan's  forceps  and  fulcrum  for  tooth 
luxation,  222. 


Cap  crown,  construction  of,  235. 

Caries  induced  by  irregularities,  31. 

Case's  retainer,  93. 

Case,  C.  S.,  regulating  methods,  64. 

Case's  regulating  devices,  189,  190, 
195,  214. 

Cells  of  destruction  of  the  pericemen- 
tum, 53. 

Cementoblasts,  53. 

Central  incisors,  separation  of,  231. 

Centrals,  torsion  of,  39,  166. 

China-grass  line,  use  of  in  regu- 
lating, 84. 

Chin-pieces  for  retraction  of  lower 
jaw,  199,  200. 

Cleansing  solutions,  246,  247. 

Cof&n,  W.  H.,  regulating  methods, 
105,  120. 

Coffin  split  plate,  Goddard's  modifi- 
cation of,  170. 

Combination  appliance  for  expansion, 
168. 

Compressed  wood  for  regulating  ap- 
pliances, 82. 

Constricted  arch,  27. 

Copper,  cleansing  solution  for,  247. 

Correction,  advisability  of,  32. 

Cortical  layer  of  maxillse,  peculiarity 
of,  69. 

Crib,  Jackson's,  110,  133. 

Cleanliness,  maintenance  of  in  regu- 
lating appliances,  87. 

Crowded  teeth,  regulation  of,  226. 

Cryer,  M.  H.,  on  tonsillar  inflamma- 
tion as  a  cause  of  irregularities, 
21. 

Cunningham,  G.,  immediate  method 
of,  223. 

Curved  spring  and  bands  device,  172. 

Cuspids,  abnormal  eruption  of,  44, 
47. 

—  regulation  of,  135. 

—  retraction  of,  101. 

—  temporary,  evil  results  of  extrac- 

tion, 16. 


252 


INDEX. 


Darby,  E.  T.,  regulating  de\'ice,  144. 

Davenport,  Dr.,  case  of  lual-occlu- 
sion,  209. 

Deciduous  teeth,  early  extraction  of, 
14. 

irregularity  of,  15. 

long  retention  of,  14. 

Dentition,  completion  of  before  oper- 
ation, 40. 

Dodge's  screw  device  for  regulating, 
130. 

Double  torsion,  157,  163. 

Dynamics  of  tooth-movement,  58. 

Early  interference,  when  justifiable, 

37. 
Eggleston,    Dr.,    case   of  anomalous 

development,  230. 
Elasticity  in   regulating  appliances, 

66. 
Electro-plating,  methods  of,  245. 
Expansion    devices    for    regulating, 

104,  106,  108,  169. 

—  method,  Coffin's,  105. 
Extraction  as  related  to  orthodontia, 

42. 
Extrusion  of  teeth,  57,  211,  215. 

Facial  appearance,  marring  of  by 
irregularities,  29. 

—  deformities  from  protruding  jaws, 

175. 
Family  types  of  jaws,  35. 
Farrar,  J.   JST.,   regulating  methods, 

94,  144. 
Faulty  occlusion,  35. 
Ferrules,  construction  of,  234. 
First  permanent  molars,   extraction 

of,  49. 
Fixed    plane  device  in   regulating, 

118. 
Flagg,  J.  F.,  regulating  device,  137. 
Force,  projjer  application  of,  62. 

—  results  of  on  tooth-movement,  55. 
Forceps,  use  of  in  delayed  eruption 

of  teeth,  217. 

Grange  measurements,  comparative 
table  of,  244. 

German  silver  for  regulating  appli- 
ances, 80,  191. 

—  —  gilding  of,  245. 
Gilding  solutions,  250. 
Goddard's   regulating  devices,    128, 

168,  169,  170,  183,  210,  212,  216. 
Gold   bar  and    vulcanite    plate    for 
retraction,  178. 


Gold,  cleansing  solution  for,  247.  ■ 
—  use  of  for  regulating  appliances, 

81. 
Guilford's  regulating  appliances,  187, 

200,  216;  228. 

Habits,  bad,  irregularities  caused 
by,  21. 

Hard -soldering,  suggestions  for,  240. 

Health,  consideration  of,  in  correc- 
tion of  irregularities,  33. 

Herbst  method  of  intrusion,  212. 

Hereditary  irregularities,  12. 

Hooked  bands,  construction  of,  237. 

How,  W.  S.,  treatment  of  elongated 
teeth,  230. 

Hundemaul,  25. 


Impression  cups,  best  form  of,  71. 

Impression-taking,  71. 

Incisors,  device  for  retraction  of,  178. 

—  extraction  of  for  regulating,  45. 

—  lower,  crowded,  226. 

—  lower,  regulating  plate  for,  123. 

—  regulation  of,  116. 

—  retraction  and  intrusion  of,  213. 
Inclined-plane  plate  for  moving  in- 
cisors, 202. 

Inclined-i)lane     principle     in    tooth 

movement,  h'6,  117. 
Inferior  teeth,  retraction  of,  196. 
Injuries,    accidental,    as   a  cause   of 

irregularities,  19. 
Inlocked  laterals,  movement  of,  118. 
Interdental  spaces,  abnormal,  13. 
Intrusion  of  teeth,  57,  211. 
Iridio-platinum,  use  of  in  regulating 

appliances,  79. 
Irregularities,  etiology  of,  12. 

—  evils  resulting  from,  29. 

—  surgical  correction  of,  220. 
Irregularity,  definition  of,  10. 

Jack's  retraction  appliance,  180,  182. 

Jackson,  V.  H.,  method  of  regula- 
ting, 109,  133. 

Jackson's  regulating  devices,  155, 
156,  163,  196,  197. 

Jaw,  lower,  protrusion  of,  196. 

Kells's  regulating  device,  142. 
Kingsley's  regulating   devices,   154, 

178,  200,  227. 
Kirk,  E.  C,  regulating  device,  131. 


INDEX. 


253 


Ljancet  arch,  26. 

Lateral  occlusion,  lack  of,  209. 

Laterals,  inlocked,  .38. 

Lever  principle  in  tooth-movement, 

63,  65. 
Leverage,  principles  of,    for  moving 

roots,  189. 
Ligatures,  use  of  in  regulating,  84, 

136. 
Linen  floss,  use  of  in  regulating,  84. 
Lip-sucking,    influence     of    on    the 

teeth,  23. 
Lower  arch,  expansion  of,  169. 
Lovper  jarw,  protrusion  of,  196. 

Magill  band,  96. 

Mastication,  impairment  of  by  irreg- 
ularities, 30. 

Mattesou  caps,  236. 

Matteson's  regulating  devices,  121, 
122,  131,  148,  149. 

Mechanical  powers  employed  in 
tooth-movement,  (j5. 

Median  line,  separation  in,  231. 

Metal  alloys,  cleansing  solution  for, 
246. 

—  regulating  appliances,  131. 
Metals,    simple   method   of  gilding, 

250. 
Mills,    W.    A.,   case   of  irregularity 

from  adenoid  growths,  21. 
Modelling  composition  for  impression 

taking,  71. 
Molars,  extraction  of  for  regulating, 

45. 
Mouth,  examination  of,  70. 

Nasal  growths,  irregularities  caused 

by.  20. 
Needless  extraction,  49. 
Netted   cap   for  occipital  resistance, 

185. 
Nuts,  construction  of,  241,  243. 

Occipital  resistance,  appliances  for, 
186,  187. 

Occlusion,  importance  of  to  mastica- 
tion, 30. 

—  improvement  of,  35. 

—  lack  of,  204. 

Orthodontia  as  a  specialty  of  dentis- 
try, 9. 

Osteoblasts,  53. 

Ofctolengui,  E.,  regulating  device, 
213. 

Overlapping  of  teeth,  16. 


Pain,  avoidance  of  in  regulating, 
95,  98.  ^  ^' 

Patients,  avoidance  of  discomfort  to, 
86. 

—  lack  of  appreciation  by,  35. 
Peirce,   C.    N.,    use   of   ligatures   in 

regulating,  84,  118. 

Pericementum,  physiology  of,  52. 

Permanent  teeth,  delayed  eruption 
of,  18. 

eruption  of,  15. 

injudicious  extraction  of,  17. 

Perry's  retraction  appliance,  180. 

Piano-wire,  anchorage  of  in  regulat- 
ing appliances,  179. 

—  bending  of,  239. 

—  for  regulating,  106,  109. 
Plaster  models,  regulation  b^',  152. 
Plate  and  wire  device  for  rotation, 

158. 
Plate,  band  and  bar  appliance,  131. 
Plates,  use  of  in  regulating,  76. 
Plating  battery,  248. 
Plating  without  a  battery,  250. 
Platinoid,  80,  114. 
Platinous  gold,  79. 

—  silver,  80. 

Platinum,  use  of  in  regulating  appli- 
ances, 79. 
Posterior  occlusion,  lack  of,  207. 
Power,  method  of  applying,  76. 

—  required  for  tooth-movement,  75. 
Prognathism,  25. 

—  excessive,  case  of,  203. 
Protrusion,  inferior,  25. 

—  of  lower  jaw,  treatment  of,  196. 

—  superior,  24,  175. 

Quattlebaum,  Dr.,  case  of  mal-oc- 
clusion,  205. 

Kacial  intermarriage  as  a  cause  of 
irregularities,  1.3. 

Regulating  appliances,  construction 
of,  233. 

qualities  essential  to,  85. 

Eegularity,  definition  of,  10. 

Resistance,  character  of  in  tooth- 
movement,  67. 

Resorption,  regulation  by,  68. 

Retaining  appliances,  89. 

—  fixture,  160. 

—  strips,  construction  of,  235. 
Retraction  appliances,  141,  143,  144 

196,  197,  199. 
Roots,  calcification  of,  40. 

—  movement     of      independent     of 

crowns,  189. 


254 


INDEX. 


Rotating  devices,  159,  161,  162   163 
Rotation  of  teeth,  158,  221.       ' 
Rubber  device  for  intrusion,  212. 
elastic,  use  of  in  regulating,  83. 

—  plates,  use  of  as  retaining  apoli- 

ances,  90. 

—  retaining  plate,  187. 

Saddle  regulating  device,  117. 
Screw,  expansion  by,  169. 
Screw-jack  regulating  appliance,  101, 
102,  124. 

—  use  of  in  regulating,  154. 
Screw  principle  in  tooth-movement 

66,  94,  ' 

Screws,  construction  of,  241    24?> 
Sea-tangle,  use  of  in  regulating '  82 
Sex,  consideration  of  in  correction  of 

irregularities,  34. 
Side  crib,  Jackson's,  111. 
Siegfried's    regulating    spring,    126, 

"^ modification  of,  166 

Simplicit.v  in  regulating  devices,  85. 

bkeletou  sknll-cap,  200. 

Skull-cap,  Guilford's,  188. 

Slotted  vulcanite  plates  with  screw- 
jack,  154.  I 

Soft-soldering,  method  of,  239  I 

Speech,  defective,  caused'  by  irreo-u- 
larities,  29.  ^         o 

Spring  and  crib  appliance,  155. 

—  bar  and  band  for  rotation,  162 

—  regulating  device,  Talbot's,  153 
Stability,  importance  of  in  regulating 

appliances,  88. 
Steel,  cleansing  solution  for,  246 

—  plating  of,  250. 

—  use  of  for  regulating  appliances,  81 
Superior  arch,  general  expansion  of, 

171.  ' 

Supernumerary  teeth,  18. 
Surgical  correction  of  irregularities 

Symmetrical  extraction,  48. 

Talbot  E  S.,  regulating  devices, 
loo,  loo. 

—  surgical  treatment  of  irregulari- 
ties, 223. 


Teeth   deciduous,  long  retention  of, 
14.  ' 

—  delayed  eruption  of,  215. 

—  elongation  of,  211. 

—  elongated,     improvement 

grinding,  230. 

—  imperfect  occlusion  of,  204. 

—  normal    arrangement    of   in    the 

dental  arch,  10. 


of     by 


Teeth    permanent,  delayed  eruption 
or,  lo, 

—  permanent,  eruption  of,  15. 

{  —  premature,  extraction  of   17 

!  —  regulation  of  for  superior  protru- 

j  sion,  177. 

I  —  retention  of  in  situ  after  moving, 

—  rotation  of,  103,  221. 

—  rules  for  extraction  of  for  regula- 

ting purposes,  42. 
I  —  supernumerary,  18. 

—  torsion  of,  157. 
Thumb-sucking,  influence  of  on  the 

teeth,  22. 

Tomes,  C.  S.,  on  the  lancet  arch,  27 

lomes,    Sir  J.,    early   treatment   of 
I  irregularities,  221. 

I  Tools  for  construction  of  regulating 
appliances,  233. 

Tooth  movement,  dynamics  of,  58 

physiology  of,  50. 

Tooth-pulp,  physiology  of,  52. 

Tooth-shaping,  228. 

Tooth-substance,  injury  to  by  regu- 
{  lating  appliances,  88. 

Torsion,  121. 

—  causes  of,  18,  157. 

Tube,^band    and    spring  appliance. 

Tubing,  regulating,  construction  of 
237,  238. 

Tucker,  E.  G.,  introduction  of  rub- 
ber tubing,  83. 

Vulcanite  bite-plate,  176. 

—  plate  and  coiled  spring,  153. 

—  plate  and  gold  wire  springs,  142. 
plate  with  piano-wire  springs,  134. 

—  plate  with  screws,  130. 

—  use  of  for  regulating  appliances, 

81. 


Wadsworth's  regulating  device,  179. 
Wedge  principle  in  tooth-movement 

Whitney,  J.  M.,  on  irregularities,  13, 

note. 
Willis,    Dr.,   case   of  mal-occlusion, 

207.  ' 

Winner,  Dr.,  case  of  inferior  nrotru- 

sion,  201. 
Wire  and  band  appliance,  113. 
Wire  articulator,  73. 
Wire-drawing,  process  of,  238. 
Wire  spring  regulating  device,  156. 
Wires,  lengthening  of  in  regulating 

devices,  108. 


